Abstracts

Rationale: To calculate and compare the incremental cost-utility ratios for standard antiepileptic drug (AED) therapy with and without adjunctive lacosamide in patients with uncontrolled partial-onset seizures in Canada. Methods: The economic model was based on a decision analytic approach that simulates the treatment pathway of a hypothetical patient over a period of two years from the Ministry of Health (MoH) and Societal perspectives in Canada in 2011. The decision tree was split into four phases of six months each during which patients could become seizure free, experience a seizure reduction, or withdraw due to non-response (responder defined as ≥50% reduction in seizures). The Standard Therapy arm included five AEDs: carbamazepine, lamotrigine, levetiracetam, topiramate, and phenytoin. The likelihood of being in a particular health state was estimated from pooled clinical trial data. Resource utilization associated with AEDs, General practitioner visits, Specialist visits, Hospitalizations, Emergency Room visits, Pre-surgical evaluation and surgery were included. Costs and utility values attached to various health states were taken from standard reference lists or the published literature. Results: Over a two year period, treating patients with lacosamide plus Standard Care would result in a total cost of $12,611 CAD per patient as compared with $11,144 for Standard Care (+placebo). Initial treatment with lacosamide + Standard Therapy and Standard Therapy (+placebo) resulted in 1.24 quality adjusted life-years (QALYs) gained and 1.20 QALYs gained, respectively. From the MoH perspective, the incremental cost was $39,156 per incremental QALY gained versus Standard Care (+placebo). From the societal perspective, the incremental cost was $32,334 per incremental QALY gained versus Standard Care (+placebo). Results of the probabilistic analysis revealed that at a willingness-to-pay threshold of $50,000 per QALY, lacosamide + Standard Therapy is cost effective relative to Standard Therapy (+placebo) in approximately 90% of the scenarios. Conclusions: Lacosamide was shown to be a cost-effective adjunctive treatment in patients with uncontrolled partial-onset epilepsy in Canada. Sponsored by UCB