title: Budget impact of perampanel as adjunctive treatment of uncontrolled partial-onset and primary generalized tonic-clonic seizures in the United States.
abstract: To evaluate the budget impact (BI) of adopting perampanel for adjunctive treatment of partial-onset seizures (POS), with or without secondarily generalized seizures, and the adjunctive treatment of primary generalized tonic-clonic seizures (PGTCS) in patients 12years or older in the United States.
  
  
  
  A BI model was developed to estimate the potential BI of adopting adjunctive perampanel from a US payer (direct costs only) and societal (direct and indirect costs) perspective over a 5-year period. Efficacy data for perampanel and antiepileptic drug (AED) maintenance therapy were obtained from perampanel phase III clinical trials. Drug, direct medical (healthcare provider, emergency room, and hospitalizations), and indirect (productivity loss) costs were obtained from appropriate sources (e.g., AnalySource® Online [wholesale acquisition costs], 2013 Optum Insight Clinformatics Database [market share percentages, direct medical costs per unit], and 2011-2013 National Health and Wellness Survey [NHWS; healthcare resource utilization, overall work impairment, and baseline distribution of patients across the 4 health states]). Mapping of seizure frequency to medical resource utilization and work impairment was obtained from Kantar Health's NHWS.
  
  
  
  In a hypothetical health plan of 1 million members, 660 (0.066%) members ≥12years old had uncontrolled POS (395 [59.8%]) or PGTCS (265 [40.2%]). During the first 5years of adoption of perampanel, absolute BI (including drug, direct medical, and indirect costs) was $852, $2124, $3855, $5318, and $6397, respectively, for a cumulative absolute BI of $18,545. Drug cost was estimated to increase by $13,888, $34,646, $62,863, $86,728, and $104,326, respectively; however, this cost would be mostly offset by decreases in direct medical ($5041, $12,576, $22,818, $31,481, and $37,869, respectively) and indirect ($7995, $19,946, $36,190, $49,929, and $60,060, respectively) costs. Total per-member-per-month cost (drug and direct medical costs) was estimated to increase by $0.0007, $0.0018, $0.0033, $0.0046, and $0.0055 from years 1 to 5.
  
  
  
  Based on results of this BI model, increased cost of adopting perampanel in a health plan of 1 million members would be minimal for payers, and societal costs would be close to neutral.
authors.affiliation: Geneconomics Inc., 1372 rue du crepuscule, Levis, QC G7A 4K3, Canada. Electronic address: gabrielt.ecn@gmail.com.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Tremblay
authors.affiliation: VEB Healthcare LLC, Morristown, NJ 07960, USA. Electronic address: vbarghout@vebhealthcare.com.
authors.forename: Victoria
authors.initials: V
authors.lastname: Barghout
authors.affiliation: Pharmerit North America LLC, 4350 East-West Highway, Bethesda, MD 20814, USA. Electronic address: vpatel@pharmerit.com.
authors.forename: Vardhaman
authors.initials: V
authors.lastname: Patel
authors.affiliation: Eisai Inc., 155 Tice Boulevard, Woodcliff Lake, Woodcliff Lake, NJ 07677, USA. Electronic address: Wan_Tsong@eisai.com.
authors.forename: Wan
authors.initials: W
authors.lastname: Tsong
authors.affiliation: Eisai Inc., 155 Tice Boulevard, Woodcliff Lake, Woodcliff Lake, NJ 07677, USA. Electronic address: Jason_Wang@eisai.com.
authors.forename: Zhixiao
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000927:Anticonvulsants / Q000191:economics* / Q000627:therapeutic use; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D006306:Health Surveys; D006760:Hospitalization; D006801:Humans; D008297:Male; D018803:Models, Economic; D009570:Nitriles; D011728:Pyridones / Q000191:economics* / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy*; D014481:United States
chemical_list: D000927:Anticonvulsants; D009570:Nitriles; D011728:Pyridones; C551441:perampanel
keywords: Antiepileptic drugs; Budget impact; Epilepsy; Partial-onset seizures; Perampanel; Primary generalized tonic–clonic seizures