Abstract
Introduction: China has ~6 million patients with active epilepsy every year, around 60% of whom suffer from partial-onset seizures. Perampanel (PER) is a novel anti-epileptic drug for partial-onset seizures. PER has been included in the latest Chinese National Reimbursement Drug List (NRDL) in 2020. However, there is still a lack of evaluation evidence on the value of PER in China.Methods: This study selected a health system perspective. A Markov model was established to simulate the lifelong transition of different response levels and calculate the number of seizures in Chinese patients. Based on the utility value and mortality risk, the life years and quality-adjusted life years (QALYs) of patients using PER vs. lacosamide (LCM) were estimated. Efficacy data were derived from clinical trials and the literature. Cost data (in US dollars) included drug costs and medical service costs. A lifetime horizon was adopted. Health outcomes and costs were discounted at an annual discount rate of 5%. Deterministic sensitivity analysis, probability sensitivity analysis, and scenario analysis were performed. The impact of the inclusion of PER in the NRDL on the medical insurance budget over 3 years (2021–2023) was also estimated.Results: Cost-effectiveness analysis indicates that 8 mg/day of PER increases QALYs by 0.054 and saves costs by $2,390 compared with 400 mg/day of LCM. 4 mg/day of PER increases QALYs by 0.010 and saves costs by $860 compared with 200 mg/day of LCM. Deterministic sensitivity analysis reveals that utility value and the extreme discount rate are the factors with the greatest impact on the incremental cost-effectiveness ratio. Probabilistic sensitivity analysis and scenario analysis show that the results are robust. Budget impact analysis indicates that after inclusion of PER in the NRDL, the incremental budget would be $1.28, $2.83, and $4.56 million from 2021 to 2023, respectively, but covering more eligible epileptic patients in the same time (1,918, 4,287, and 8,983, respectively).Conclusion: PER (8 or 4 mg/day) is of relatively high value as an add-on therapeutic regimen for partial-onset seizures in China because of its dominate advantage of cost-effectiveness over LCM and acceptable budget impact.
Highlights
China has ∼6 million patients with active epilepsy every year, around 60% of whom suffer from partial-onset seizures
Compared with LCM 400 mg/day, PER 8 mg/day reduces the number of seizures per capita by 141 times, with an incremental life year (LY) of 0.061, an incremental quality-adjusted life years (QALY) of 0.054, and a direct medical cost saving of $2,390
Compared with LCM200 mg/day, PER 4 mg/day reduces the number of seizures per capita by 72 times, with an incremental LY of 0.012, an incremental QALY of 0.010, and a cost savings of $860
Summary
China has ∼6 million patients with active epilepsy every year, around 60% of whom suffer from partial-onset seizures. Perampanel (PER) is a novel anti-epileptic drug for partial-onset seizures. China has ∼6 million patients with active epilepsy (AE, defined as two or more unprovoked seizures in the past year) every year, and 60% of them suffer from partial-onset seizures [2, 3] with a mortality risk of 2–3 times that of the general population [4]. Long-term administration of anti-epileptic drugs (AEDs) and other costs of diagnosis and treatment impose a heavy economic burden to families. In 2015, another study on the disease burden in central China showed that the average annual cost of epileptic patients reached $949 [7]. The prevention and treatment of epilepsy is a medical problem, and a vital public health and social problem
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