Director, Health Economics and Outcomes Research Sunovion Pharmaceuticals Inc. Marlborough, Massachusetts
Rationale: It is not known whether early use of third-generation antiepileptic drugs (AEDs), such as eslicarbazepine acetate (ESL), is associated with better economic outcomes relative to other agents used as first-line. The objective of this study was to examine the association between initiating first-line monotherapy with ESL vs. a generic AED and healthcare resource utilization (HCRU) and charges in adults with treated focal seizure (FS). Methods: This was a retrospective analysis of Symphony Health’s Integrated Dataverse® open-source claims data (April 1, 2015 - June 30, 2018). Two cohorts were identified as first-line monotherapy with ESL or literature-defined generic AEDs. Index date was the first dispensed new AED prescription claim. Inclusion criteria were ≥ 1 medical claim with a FS diagnosis; ≥ 1 pharmacy claim for study AED; no AED claim prior to index date; and ≥ 1 medical and pharmacy claim in the six months prior to and after index date. The unit of analysis was the person-time block of 90 days. Baseline period was the 90-day block preceding index date. Patients had up to four 90-day blocks following index date. Linear regression models with person fixed effects assessed relative changes in HCRU and charges from baseline to follow-up. Models used inverse probability treatment weights generated from predicted propensity scores to balance baseline characteristics between cohorts. Results: Two hundred fifty and 43,220 patients initiated ESL (48.3 years; 57.2% female) or a generic AED (54.5 years; 58.1% female), respectively. Compared to patients initiating a generic AED, patients treated with ESL had additional reductions of 11.8 percentage points in the likelihood of any all-cause outpatient visits (P < 0.001), 7.4 percentage points in the likelihood of any emergency department visits (P = 0.013), and 22.7 percentage points in the likelihood of any FS-related outpatient visits (P < 0.001). Patients initiating ESL had significantly larger reductions in mean charges for all-cause medical ($2,620; P = 0.002), outpatient ($1,995; P = 0.005) and non-FS-related medical ($2,708; P < 0.001) services. Patients initiating ESL had significantly larger relative increases in mean total prescription ($1,368; P < 0.001) and AED-related prescription ($1,636; P < 0.001) charges, but significantly larger relative reductions in non-AED prescription ($269; P = 0.032) charges. Conclusions: There were significant reductions in all-cause outpatient, any emergency department, and any FS-related outpatient visits and medical and non-AED prescription charges in patients initiating first-line ESL monotherapy vs. generic AEDs. Funding: Please list any funding that was received in support of this abstract.: Sunovion Pharmaceuticals Inc.
