Cenobamate’s 12-month efficacy and economics in refractory focal epilepsy – Does it make economic sense?

<h3>Objectives</h3> To assess the efficacy and impact of adjuvant Cenobamate in adults with refractory focal epilepsy. <h3>Methodology</h3> A retrospective cohort study was conducted. Patients were commenced on adjuvant Cenobamate between January and December 2022. Change in seizure frequency, alterations to concomitant anti-seizure medications (ASMs) and hospitalisations were assessed over a twelve- month period. <h3>Results</h3> Of 142 patients, 93 (65%) were on the surgical pathway. 48 (34%) had intellectual disability. 101 (71%) patients were prescribed at least three concomitant ASMS at baseline. 30 (21%) were hospitalised at least once in the 12 months prior to Cenobamate. 90% patients remained on Cenobamate at 12 months. 84 (59%) achieved significant seizure reduction - mean dose of Cenobamate of 225mg/day. 28 patients withdrew one novel ASM (Brivaracetam/Eslicarbazepine/Perampanel); addition of Cenobamate was therefore cost neutral. Cumulative cost of Cenobamate in remainder £202000. There was a 36% reduction (70 pre, 45 post) in hospitalisations over 12 months, cost saving £15500. 9 patients deferred VNS implantation, cost saving 189,000. <h3>Conclusion</h3> Cenobamate is efficacious in refractory focal epilepsy. Twelve-month health-economic data suggests that it is ‘cost neutral’, with medication costs being offset by VNS savings and reduction in hospitalisations.