Economic evaluation of brivaracetam in the adjunctive treatment of patients with focal-onset seizure in Jordan

This study conducts a cost-effectiveness analysis of brivaracetam (BRV) compared to other 3rd-generation antiseizure medications (AEDs) for the treatment of pharmacoresistant focal-onset seizures in Jordan. A Markov model was constructed over a 2-years' time horizon for a hypothetical cohort of focal-onset seizures patients. A cycle of 3-months was adopted in our economic evaluation (total cycles of 8 cycles). Four health states were defined: seizure free, partial responders (≥50% reduction in seizure frequency), non-responders, and discontinuation. In addition to BRV, 3 treatment comparators were included in this economic evaluation: eslicarbazepine (ESL), lacosamide (LCM), and perampanel (PER). Clinical data were retired from a previously published network meta-analysis of 65 randomized controlled trials. Cost inputs were obtained from the Jordan Food and Drug Administration and local healthcare providers. Incremental Cost-Effectiveness Ratio (ICER) was calculated using the percentage of complete response (CR) in the denominator. Probabilistic sensitivity analysis was conducted to assess the robustness of the study findings. BRV was associated with the highest gains in CR over all AEDs included in this economic evaluation. The 2-year cost of ESL is JOD 4139; LCM is JOD 3078; PER is JOD 5541; BRV is JOD 3925. The incremental gain in CR with BRV was higher by 29.0%, 30.9%, and 26.4% compared to ESL, LCM, and PER, respectively. Despite these higher gains in CR with BRV versus all other AEDs in this economic evaluation, it was associated with lower cost when compared to ESL and PER at saving ICER of -JOD 737 per 1% CR achieved and -JOD 6113 per 1% CR achieved, respectively. However, BRV was associated with the ICER of JOD 2744 per 1% of CR achieved compared with LCM. These estimates were confirmed by the probabilistic sensitivity analysis. Compared to ESL and PER, BRV was associated with cost-savings. Compared to LCM, the BRV was cost-effective at the World Health Organization recommended willingness-to-pay threshold of 3× of Jordanian gross domestic product per capita.