Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, The Boston University Chobanian and Avedisian School of Medicine, USA.
Instituto de Pediatría, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile; Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Seizure. 2023 Nov;112:128-138. doi: 10.1016/j.seizure.2023.10.005. Epub 2023 Oct 10.
To describe the evolution in use and cost of antiseizure medications (ASM) in the United States of America (USA).
Retrospective descriptive study using the IBM MarketScan Commercial Database (data of privately-insured patients) for the years 2006 to 2021. We identified patients with epilepsy who were on ASM. We adjusted cost for inflation with the Gross Domestic Product Implicit Price Deflator.
We evaluated 347,158 patients (46.9 % males; median (p-p) age: 33 (17-49) years; 28 % with pediatric-onset epilepsy and 72 % with adult-onset epilepsy) with a total of 1,385,382 person-years and 588,285,065 ASM prescription days. The most commonly prescribed (as percentage of prescription days) ASMs in 2006 were valproate (18 %) and lamotrigine (17 %) in pediatric-onset epilepsy and phenytoin (21 %) and carbamazepine (17 %) in adult-onset epilepsy, but starting in the 2010s, levetiracetam and lamotrigine became the most commonly prescribed ASMs in both pediatric-onset (in 2021, levetiracetam 25 %, lamotrigine 16 %) and adult-onset (in 2021, levetiracetam 27 %, lamotrigine 20 %) epilepsy. The proportion of generic ASM use increased 3.6-fold: from 23 % of prescription days in 2006 to 83 % of prescription days in 2021. The median (p-p) average wholesale price (AWP) per person-year increased by 102 % from $2,684 ($990-$5,509) in 2006 to $5,417 ($2,858-$12,310) in 2021. The increases were greater in absolute terms for brand-name ASMs by 419 %: $3,109 ($1,564-$5,068 in 2006 and $16,149 ($12,950-$23,377) in 2021 than for generic ASMs by 462 %: $699 ($457-$1,678) in 2006 and $3,931 ($2,618-$6,081) in 2021. The costs directly borne by the patient (copay, coinsurance, deductibles, and pharmacy processing fees) increased by 69 % for brand-name ASMs from $393 ($246-$570) in 2006 to $665 ($335-$1,308) in 2021, but decreased by 37 % for generic ASMs from $147 ($98-$213) in 2006 to $92 ($51-$141) in 2021.
The median cost of ASMs per person-year approximately doubled from 2006 to 2021. The increase in use of generic ASMs probably helped buffer the growing costs of ASMs. However, generic ASMs already represent 83 % of prescription days in 2021, with limited room to further contain costs by just increasing the proportion of generics.
描述美国抗癫痫药物（ASM）的使用和成本演变。
使用 IBM MarketScan 商业数据库（私人保险患者数据）进行回顾性描述性研究，时间范围为 2006 年至 2021 年。我们确定了正在服用 ASM 的癫痫患者。我们使用国内生产总值隐含价格平减指数对成本进行了通胀调整。
我们评估了 347158 名患者（46.9%为男性；中位数（p-p）年龄：33（17-49）岁；28%为儿童期起病癫痫，72%为成人期起病癫痫），共 1385382 人年和 588285065 天 ASM 处方。2006 年最常开的处方药物（按处方天数计算）是丙戊酸钠（18%）和拉莫三嗪（17%），在儿童期起病癫痫患者中；苯妥英（21%）和卡马西平（17%），在成人期起病癫痫患者中，但从 2010 年代开始，左乙拉西坦和拉莫三嗪成为儿童期（2021 年，左乙拉西坦 25%，拉莫三嗪 16%）和成人期（2021 年，左乙拉西坦 27%，拉莫三嗪 20%）起病癫痫患者最常开的 ASM。仿制药的使用率增加了 3.6 倍：从 2006 年的 23%增加到 2021 年的 83%。人均年平均批发价（AWP）中位数（p-p）增加了 102%，从 2006 年的 2684 美元（990-5509 美元）增加到 2021 年的 5417 美元（2858-12310 美元）。从绝对值来看，品牌 ASM 的增幅更大，增加了 419%：从 2006 年的 3109 美元（1564-5068 美元）增加到 2021 年的 16149 美元（12950-23377 美元），而仿制药的增幅为 462%：从 2006 年的 699 美元（457-1678 美元）增加到 2021 年的 3931 美元（2618-6081 美元）。品牌 ASM 患者直接承担的费用（自付额、共付额、免赔额和药房处理费）增加了 69%，从 2006 年的 393 美元（246-570 美元）增加到 2021 年的 665 美元（335-1308 美元），而仿制药的费用减少了 37%，从 2006 年的 147 美元（98-213 美元）减少到 2021 年的 92 美元（51-141 美元）。
ASM 人均年费用中位数从 2006 年到 2021 年翻了一番。ASM 使用率的增加可能有助于缓冲 ASM 成本的不断上升。然而，仿制药目前已占 2021 年处方天数的 83%，通过仅增加仿制药的比例来进一步控制成本的空间有限。
