Use and cost comparison of clobazam to other antiepileptic drugs for treatment of Lennox-Gastaut syndrome

Abstract

Background: Lennox-Gastaut syndrome (LGS) is a severe form of childhood-onset epilepsy associated with serious injuries due to frequent and severe seizures. Of the antiepileptic drugs (AEDs) approved for LGS, clobazam is a more recent market entrant, having been approved in October 2011. Recent AED budget impact and cost-effectiveness analyses for LGS suggest that adding clobazam to a health plan formulary may result in decreased medical costs; however, research on clinical and economic outcomes and treatment patterns with these AED treatments in LGS is limited.Objectives: To compare the baseline characteristics and treatment patterns of new initiators of clobazam and other AEDs among LGS patients and compare healthcare utilization and costs before and after clobazam initiation among LGS patients.Methods: A retrospective study of probable LGS patients was conducted using the MarketScan® Commercial, Medicare Supplemental, and Medicaid databases (10/1/2010-3/31/2014).Results: In the Commercial/Medicare Supplemental population, clobazam users were younger, had fewer comorbidities, and more prior AED use than non-clobazam users. In the 12 months pre-treatment initiation, clobazam users had significantly more seizure-related inpatient stays and outpatient visits and higher total seizure-related (P < 0.001) and all-cause (P < 0.001) costs than non-clobazam users. Among clobazam users, when compared to the 12 months pre-clobazam initiation, seizure-related medical utilization and costs were lower in the 12 months post-clobazam initiation (P = 0.004). Total all-cause (P < 0.001) and seizure-related (P = 0.029) costs increased post-clobazam initiation mainly due to the increase in outpatient pharmacy costs. Similar results were observed in the Medicaid population.Conclusions: Baseline results suggest a prescribing preference for clobazam in severe LGS patients. Clobazam users had a reduction in seizure-related medical utilization and costs after clobazam initiation. The improvement in medical costs mostly offset the higher prescription costs following clobazam initiation.

Epidemiology, healthcare resource use, and mortality in patients with probable Lennox-Gastaut syndrome: A population-based study on German health insurance data

“…Our findings agree with previously published analyses that the healthcare costs associated with LGS are significant [6,11,13]. All previous studies note that the mean annual costs associated with probable LGS are very high; where the comparison has been shown, these costs exceed those of patients without LGS (Appendix Table S2), and also exceed those of other encephalopathies such as DS and TSC [14].…”

“…Since all previous studies have used an algorithm to detect the patients most likely to have been diagnosed with LGS, all studies refer to patients with 'probable LGS'. The algorithm used was highly consistent between these studies [6,11,13,14]. As noted previously, LGS is a predominantly childhood-onset syndrome, most commonly manifesting itself between ages 3-5 years [4], yet no previous study has included a maximum age cut-off for the first diagnosis of epilepsy as an indicator for probable LGS.…”

“…The inclusion criteria used in the previous study classified all patients with mixed types of generalized seizures and intellectual disability as having probable LGS [23]. In comparison, the present study employed selection criteria that were based on previous analyses [6,11,13], but attempted to increase algorithm accuracy by stratifying patients with probable LGS based on age at diagnosis.…”

“…The few published healthcare utilization studies in patients with LGS have all reviewed healthcare data from patients based in the USA (Medicaid and MarketScan Ò databases) [6,11,13,14]. Since all previous studies have used an algorithm to detect the patients most likely to have been diagnosed with LGS, all studies refer to patients with 'probable LGS'.…”

The direct cost of seizure events in severe childhood-onset epilepsies: A retrospective claims-based analysis

“…Claims analyses of patients with possible DS reported average per-patient-per-year (PPPY) all-cause costs of $30,094 and $32,572 (2017 US dollars) in patients with commercial coverage and Medicaid, respectively [15]. Studies specifically examining all-cause healthcare costs of epilepsy in patients with LGS have yielded PPPY averages ranging from $28,241 to $40,000 depending on patient age [16], to a high of $73,486 in a specific subpopulation with LGS [17]. Another claims analyses of patients with possible LGS reported average PPPY all-cause costs of $65,026 and $63,930 (2017 US dollars) in patients with commercial and Medicaid coverage, respectively [18].…”