Pharmaceutical CBD Is Cost-Effective for Treatment-Resistant Epilepsy in the Netherlands

For Lennox-Gastaut syndrome (LGS), adding CBD cost an extra 28,338 euros but gained 1.318 QALYs, yielding a cost per QALY of 21,493 euros, well below the Dutch willingness-to-pay threshold of 80,000 euros. For Dravet syndrome (DS), CBD dominated usual care: it saved 23,642 euros while gaining 0.868 QALYs. The probability of cost-effectiveness was 96% for LGS and 99% for DS.

Cohort-based Markov model from the Dutch societal perspective using a lifetime (90-year) horizon with 3-month cycles. Clinical inputs from CBD clinical trials, drug costs based on 12 mg/kg/day mean dosage, discount rates of 4% for costs and 1.5% for outcomes. Deterministic and probabilistic sensitivity analyses were performed.

Reimbursement decisions for expensive medications require economic evidence. This analysis supported the Dutch decision to reimburse pharmaceutical CBD (Epidyolex) for treatment-resistant epilepsy since December 2022, showing it provides good value for money.

As pharmaceutical CBD gains approval in more countries, economic analyses like this help other healthcare systems decide on reimbursement. The finding that CBD saves money in Dravet syndrome is particularly compelling for payers.

Expert elicitation was used to fill data gaps in healthcare resource utilization and quality-of-life measures. Results are specific to the Dutch healthcare system and pricing. Long-term effectiveness was extrapolated from shorter-term trial data.