title: Budget impact analysis of antiepileptic drugs for Lennox-Gastaut syndrome.
abstract: BACKGROUND
  In October 2011, clobazam was FDA-approved for adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS), a debilitating childhood epilepsy characterized by drop attacks, for patients 2 years and older.
  
  
  OBJECTIVE
  To assess the budget impact of adding clobazam to an antiepileptic drug (AED) portfolio containing topiramate, lamotrigine, and rufinamide in a hypothetical, 100,000-member commercially insured health plan.
  
  
  METHODS
  Patient characteristics and AED efficacy (decrease in drop-seizure frequency) were modeled with clinical data. Medical costs were derived from administrative claims data from a large U.S. managed health plan, with the assumption that 2.3% of drop seizures required medical care. Two-year budget impact was measured. Results were expressed as the overall difference in costs (medical and pharmacy) to a health plan and cost per member per month (PMPM) after addition of clobazam. Analyses of alternative scenarios were performed.
  
  
  RESULTS
  With the assumption that 0.04% of the plan population had LGS, adding clobazam to the formulary resulted in cost savings of $98,059 in year 1 and $131,690 in year 2 (savings of $0.08 and $0.11 PMPM, respectively). Analyses of alternative scenarios with lower seizure rates upon discontinuation or greater long-term efficacy for lamotrigine and topiramate did not substantially alter conclusions. The assumption that fewer drop seizures required medical care resulted in a savings of approximately $5,000 per year with clobazam, which suggested that medically attended drop seizures drive costs.
  
  
  CONCLUSIONS
  Medically attended drop seizures are a major cost driver for LGS patients. Adding clobazam to a health plan formulary can have a positive overall budget impact through decreased medical costs associated with drop seizures.
authors.affiliation: OptumInsight, 10 Cabot Rd., Ste. 304, Medford, MA 02155, USA. michelle.skornicki@gmail.com.
authors.forename: Michelle
authors.initials: M
authors.lastname: Skornicki
authors.forename: Karen M
authors.initials: KM
authors.lastname: Clements
authors.forename: Amy K
authors.initials: AK
authors.lastname: O'Sullivan
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use*; D002017:Budgets; D002648:Child; D002675:Child, Preschool; D000078306:Clobazam; D017046:Cost Savings; D016208:Databases, Factual; D005569:Formularies as Topic; D006801:Humans; D065768:Lennox Gastaut Syndrome / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D008329:Managed Care Programs / Q000191:economics; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines; D000078306:Clobazam