Cost-effectiveness of cenobamate as a therapeutic alternative for the treatment of focal epilepsy in adults with inadequate seizure control

Introduction: This study assesses the cost-effectiveness of cenobamate relative to brivaracetam, lacosamide, eslicarbazepine acetate, and perampanel in the management of focal onset seizures (FOS). The objective is to determine whether cenobamate offers enhanced therapeutic benefits and economic viability. Methods: A comprehensive cost-effectiveness analysis was performed using a lifetime horizon model that encompassed drug acquisition costs, background therapy, monitoring, and seizure management expenses. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate the quality-adjusted life years (QALYs) gained from cenobamate compared to its alternatives. Results: Findings revealed that cenobamate while incurring slightly higher initial acquisition costs, leads to significant cost offsets due to reductions in overall seizure management expenses and minimized reliance on subsequent anti-seizure medications (ASMs). Additionally, cenobamate significantly enhances patient quality of life, demonstrated by superior response rates (seizure reduction >50%) and remission rates (100% seizure reduction) compared to the analyzed comparators. The cost-effectiveness analysis established that cenobamate is dominant across all evaluated treatment options, achieving greater QALYs at a lower total cost. Conclusion: Cenobamate represents a more effective and economically advantageous treatment for patients with FOS when compared to brivaracetam, lacosamide, eslicarbazepine acetate, and perampanel. Its capacity to improve seizure control and enhance the quality of life, alongside favorable economic implications, underscores its position as the preferred therapeutic option in this patient population.