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Healthcare utilization and associated costs following initiation of perampanel in patients with epilepsy

      Highlights

      • Perampanel has a unique mechanism of action which blocks glutamate activity at postsynaptic AMPA receptors.
      • In controlled trials and meta-analyses perampanel has been shown to reduce the frequency of seizures in patients with epilepsy.
      • We considered the association of perampanel with resource use in a before-after comparison and compared with controls.
      • Following initiation with perampanel, patients had fewer inpatient and accident and emergency contacts.
      • Overall annualized healthcare costs were reduced following initiation with perampanel, offering potential for cost saving.

      Abstract

      Purpose

      We compared health service utilization and costs for patients with epilepsy before and after initiation of perampanel and compared with matched controls.

      Method

      Patients were selected from the Clinical Practice Research Datalink (CPRD). Patients initiating perampanel were matched to controls initiating an alternate add-on therapy for the same underlying epilepsy subtype. First prescription defined index date. Primary and secondary care contacts and associated costs were aggregated in the 12 months before and after index date. Secondary care contacts were available for a subset (~60%) of patients.

      Results

      Three hundred and forty-three patients treated with perampanel were identified. One hundred and eighty-three (53.4%) were male, mean age was 39.1 (sd: 16.0). Mean epilepsy duration was 21.1 (standard deviation (sd): 13.3) years. Two hundred and eighty-seven (83.7%) were matched to controls. Inpatient admissions with a primary diagnosis of epilepsy (0.5 versus 0.2 per patient-year (ppy), p = 0.002) and neurology specific outpatient appointments (3.2 versus 2.9 ppy, p = 0.041) were significantly reduced following initiation with perampanel. Total costs attributable to epilepsy (£1889 to 1477 ppy) and overall secondary costs (£2593 to £2102) were also significantly reduced. There was no significant difference in primary care, outpatient, or general inpatient admissions. Compared with controls, there was a significant reduction in primary epilepsy admissions (incidence rate ratio (IRR): 0.423; 95% Confidence intervals (CI): 0.198–0.835) but a significant increase in outpatient appointments (1.306; 95% CI: 1.154–1.478) and accident and emergency contacts (1.603; 95% CI: 1.081–2.390) for patients treated with perampanel.

      Conclusion

      Treatment with perampanel is associated with reduced epilepsy-related inpatient admissions and accident and emergency contacts.

      Keywords

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