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

The takeaway

An economic analysis found that adding pharmaceutical CBD to standard treatment was cost-effective for Lennox-Gastaut syndrome and actually saved money for Dravet syndrome patients in the Netherlands.

Health economists, epilepsy specialists, and healthcare policymakers

CBD saved 23,642 euros per patient in Dravet syndrome

What the researchers found

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.

Why it matters

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.

The numbers in context

LGS: 28,338 euros additional cost, 1.318 QALYs gained, ICER 21,493 euros/QALY. DS: 23,642 euros saved, 0.868 QALYs gained (dominant). Willingness-to-pay threshold: 80,000 euros/QALY. Cost-effective probability: 96% (LGS), 99% (DS). Mean dosage: 12 mg/kg/day.

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Rigorous economic model using clinical trial data with comprehensive sensitivity analyses, though dependent on assumptions and expert elicitation for some inputs.

When this study was published

2024 study

The bigger picture

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.

Questions still open

Would these results hold in healthcare systems with different pricing structures? How does real-world effectiveness compare to trial-based efficacy used in the model? What is the budget impact of broader CBD adoption?

Common questions

Is pharmaceutical CBD worth the cost for severe epilepsy?

According to this Dutch analysis, yes. CBD was cost-effective for Lennox-Gastaut syndrome and actually saved money for Dravet syndrome compared to standard care alone.

How much does CBD treatment for epilepsy cost?

In this model, adding CBD to standard treatment cost an extra 28,338 euros over a lifetime for LGS patients, but this was offset by health gains. For Dravet syndrome, CBD actually reduced total costs by 23,642 euros.

Read the original research

Cost-Utility Analysis of Add-on Cannabidiol vs Usual Care Alone for the Treatment of Seizures in Patients With Treatment-Resistant Lennox-Gastaut Syndrome or Dravet Syndrome in the Netherlands.

Journal of health economics and outcomes research, 11(2), 168-179

View on PubMed ↗Publisher’s paper ↗

Citation

Siddiqui, Jamshaed; Bowditch, Sally. (2024). Cost-Utility Analysis of Add-on Cannabidiol vs Usual Care Alone for the Treatment of Seizures in Patients With Treatment-Resistant Lennox-Gastaut Syndrome or Dravet Syndrome in the Netherlands.. Journal of health economics and outcomes research, 11(2), 168-179. https://doi.org/10.36469/001c.126071