Healthcare resource utilization and costs before and after lacosamide initiation as adjunctive therapy among patients with epilepsy in the United States

Therapy outcomes associated with prescription cannabidiol use at 12 months post-initiation

OBJECTIVE

This study evaluated prescription cannabidiol (CBD) outcomes during the first 12 months of therapy.

METHODS

A single-center, prospective cohort study was performed including patients prescribed CBD from January 2019 - April 2020, excluding clinical trial patients and those using external specialty pharmacy services. The primary outcome wasepilepsy-related emergency healthcare service (EHS) use within 12 months of initation. Secondary outcomes included prescription CBD discontinuation rate and reason and concomitant anti-seizure medication (ASM) use. A multiple logistic regression model evaluated the odds of EHS use, adjusting for initial concomitant ASM count, age, and insurance type.

RESULTS

The 136 patients included were 85% white, 50% female, and 68% pediatric. EHS utilization occurred in 37% (n = 50) of patients; 29 patients (21%, n = 20 pediatric, n = 9 adult) had at least one emergency department (ED) visit, 9 patients (7%) had two or more; 30 patients (22%, n = 22 pediatric, n = 8 adult) had at least one hospitalizaion. Median time to first ED and hospitalization was 69 (IQR 31-196) and 104 (IQR 38-179) days, respectively. Prescription CBD was discontinued in 31 patients (23%, n = 18 pediatric, n = 13 adult), due to major side effects (n = 12, 39%), common side effects (n = 11, 36%), and unsatisfactory response (n = 11, 36%). There was no significant change in concomitant ASM use.

CONCLUSION

Despite potential benefits of prescription CBD, many patients utilize EHSs in the first 12 months of treatment with minimal changes in concomitant ASM use.

Real-world safety of Lacosamide: A pharmacovigilance study based on spontaneous reports in the FDA adverse event reporting system

INTRODUCTION

Lacosamide is licensed for the treatment of focal seizures in both adults and children, however there is little information available on its adverse reactions. Using the FDA Adverse Event Reporting System (FAERS), we seek to assess adverse occurrences that may be related to Lacosamide.

METHODS

On the basis of the FAERS database from the fourth quarter of 2008 to the second quarter of 2022, disproportionality analysis was carried out using the reporting odds ratio (ROR) method, the United Kingdom Medicines and Healthcare Products Regulatory Agency omnbius standard (MHRA) method, and the bayesian confidence propagation neural network (BCPNN) method. We extracted valuable positive signals for designated medical event (DME) screening, focused on the evaluation and comparison of safety signals appearing in DME with system organ classification (SOC) analysis.

RESULTS

A total of 10,226 adverse reaction reports with Lacosamide as the primary suspect drug were obtained, with 30,960 reported cases, detecting 232 valuable positive signals, involving a total of 20 SOCs, of which the most frequently reported SOCs were nervous system disorders (6537 cases, 55.21%), psychiatric disorders (1530 cases, 12.92%), injury poisoning and procedural complications (1059 cases, 8.94%). According to 232 valuable positive signals with DME screening results, two signals of stevens-johnson syndrome and ventricular fibrillation were consistent with PT signals on the DME list, with the two SOCs focusing on skin and subcutaneous tissue disorders and cardiac disorders, respectively.

CONCLUSIONS

Our research demonstrates that the clinical use of Lacosamide should be noticed and avoided in relation to ADRs since it raises the risk of cardiac arrest, ventricular fibrillation, stevens-johnson syndrome, and rhabdomyolysis.

Economic aspects of treating seizure clusters

Seizure clusters may initiate a chain of events that have economic as well as clinical consequences. The potential economic consequences of seizure clusters must be weighed against the cost of medication to attenuate them. This is true both for individual patients and for society. Data needed for economic analyses include the chance that a cluster will progress to an adverse outcome, such as a need for emergency care, the costs of such an outcome, the cost of a rescue medication (RM), and the effectiveness of the RM. Indirect costs, such as lost employment for patients and caregivers, must also be considered. Several types of economic analyses can be used to determine costs and benefits of a medical intervention. There are studies comparing different RMs from an economic perspective, but there is little direct information on the costs of using an RM versus allowing clusters to run their course. However, the high expense of consequences of seizure clusters makes it likely that effective RMs will make economic as well as medical sense for many patients.

Effects of Epidiolex® (Cannabidiol) on seizure-related emergency department visits and hospital admissions: A retrospective cohort study

AIM

The aim of this study was to evaluate the potential impact of cannabidiol (CBD) on healthcare resource utilization and determine the effect of CBD on seizure-related emergency departments (ED) and hospital admissions in patients with epilepsy.

METHODS

This single-center, retrospective longitudinal cohort study included patients ≥1 year on CBD, excluding participants in CBD clinical trials or on <6 months of CBD therapy. Demographics, antiseizure medications (ASM), ED and hospital admissions were collected from the electronic medical record. Co-primary outcomes included change in seizure-related ED and hospital admissions. Secondary outcomes included change in ASMs and total ED or hospital admissions. Co-primary outcomes were assessed using generalized linear modeling. Descriptive statistics were used to analyze all other variables.

RESULTS

In the one-hundred total patients, there was no difference in either seizure-related ED visits (0.012 vs 0.011, p = 0.85) or hospital admissions per month (0.019 vs 0.021, p = 0.7). However, given the low percentage of the total cohort (n = 100) with either a seizure-related ED visits and hospital admissions (9% and 18%, respectively), a subgroup analysis was conducted. Those with seizure-related hospital admissions prior to CBD (n = 18) had significantly less seizure-related hospital admissions after initiation of CBD (23 admissions [0.104 per month] vs 15 admissions [0.055 per month], p = 0.007).

CONCLUSION

Despite the lack of statistically significant difference in primary outcomes for the total cohort, CBD may have a potential for a clinically beneficial impact in real-world settings on those patients with prior seizure-related admissions, who are the highest utilizers of healthcare resources.

Evaluation of persistence and healthcare utilization in patients treated with anti-seizure medications as add-on therapy: A nationwide cohort study in South Korea

OBJECTIVE

To compare medication adherence and healthcare utilization among patients who were treated with anti-seizure medications (ASMs) as first add-on to monotherapy for epilepsy using the national health insurance claims data.

METHODS

A retrospective observational cohort study was conducted using the Korean National Health Insurance claims data. Patients who received ASM as first add-on to monotherapy during January 2017 to February 2018 were included. The selected patients were followed up for 12 months to evaluate persistence, adherence, and healthcare resource utilization.

RESULTS

In total, 4277 patients who received ASM as first add-on to monotherapy for epilepsy were enrolled. The mean treatment duration of add-on ASM was 296.6 ± 108.6 days during the 1-year follow-up period and 64.3% of the total population were persistent on the add-on ASM at 365 days from the index date. The mean medication possession ratio (MPR) was 90.3 ± 23.7 and the proportion of adherent patients with ≥80% MPR was 79.3%. Lamotrigine (LTG), levetiracetam (LEV), oxcarbazepine (OXC), and perampanel (PER) groups showed significantly higher persistence and adherence than carbamazepine (CBZ), topiramate (TPM), and valproate (VAL) groups during the 1-year follow-up period. Significant differences in length of stays, total hospitalization cost, outpatient visit cost, and emergency cost were shown between ASM groups and LTG, LEV, OXC, and PER showed relatively low utilization and cost.

CONCLUSIONS

Better adherence was observed in LTG, LEV, OXC, and PER groups than in CBZ, TPM, and VAL groups. Healthcare utilization and related costs showed significant difference between ASM groups.

Cost-Effectiveness of Zonisamide Versus Levetiracetam in Newly Diagnosed Focal Onset Epilepsy in Serbia

OBJECTIVES

When choosing initial therapy for epilepsy, the decision should be supported by studies that include both treatment outcome and costs. This is especially important for developing countries with restricted budgets because such circumstances are also characterized by higher epilepsy prevalence rates. The aim of this study was to compare cost-utility of zonisamide (ZNS) and levetiracetam (LEV) in patients with newly diagnosed focal-onset epilepsy in the Republic of Serbia.

METHODS

A 5-state, 3-month-cycle Markov model was created to compare ZNS and LEV. The model assumed that patients whose seizures were not controlled by treatment with either ZNS or LEV would be continued on carbamazepine in controlled-release form in the second cycle and would then be treated with a pregabalin add-on if still not adequately controlled. The perspective of the Serbian Republic Health Insurance Fund was chosen, and the time horizon was 15 years. Model results were obtained after Monte Carlo microsimulation of a sample with 1000 virtual patients. Both multiple one-way and probabilistic sensitivity analyses were performed.

RESULTS

After base-case analysis, LEV was dominated by ZNS because the net monetary benefit was positive (16 940.78 ± 22 572.26 Serbian dinars; €144.09 ± €191.99) and the incremental cost-effectiveness ratio was below the willingness-to-pay threshold of 3 Serbian gross domestic products per capita per quality-adjusted life-year gained. Multiple one-way and probabilistic sensitivity analyses confirmed the results of the base-case simulation.

CONCLUSIONS

ZNS has a more beneficial cost-effectiveness ratio than LEV for the treatment of newly diagnosed focal epilepsy in Serbian milieu.