Healthcare Utilization and Costs Among Patients With Episodic Migraine Initiating Galcanezumab Versus Rimegepant for Migraine Prevention in the United States

OBJECTIVES: To compare all-cause and migraine-related healthcare resource utilization (HCRU) and costs among patients with episodic migraine initiating galcanezumab (GMB; monthly subcutaneous injectable) vs rimegepant (RIME; orally disintegrating tablet taken every other day) for migraine prevention in the United States.

METHODS: This retrospective observational study used de-identified claims data from Merative^TM MarketScan^®Databases. Adults (aged ≥18 years) initiating GMB or RIME (quantity of ≥15/month for RIME claims) for migraine prevention from June 2021 - June 2022 (first claim=index date), continuously enrolled for 12 months before (baseline) and 12 months after (follow-up) index and diagnosed with episodic migraine were included. Propensity score matching (PSM) was used to adjust for the differences in baseline demographics and clinical characteristics and baseline all-cause and migraine-related total healthcare costs. Changes in all-cause and migraine-related HCRU and costs from baseline to follow-up in the matched GMB and RIME cohorts were examined using Wilcoxon signed rank test and chi-square test.

RESULTS: A total of 880 and 1,128 patients qualified for the GMB and RIME cohorts, respectively. After PSM, 602 matched pairs (mean age of 43; 89% female) were balanced in each cohort. Over the 1-year follow-up, GMB showed a higher mean change from baseline to follow-up in all-cause total medical (inpatient + emergency room + outpatient) costs compared to RIME (∆$2371 vs. ∆$-281, p=0.3645) but ultimately 21% lower mean change in all-cause total medical+pharmacy cost compared to RIME (∆$8378 vs. ∆$10641, p<0.0001). GMB showed cost savings in migraine-related total medical costs (-∆$36 vs. ∆$33, p=0.0225) with 76% lower mean cost increase in migraine-related total medical+pharmacy cost (∆$2172 vs. ∆$9041, p<0.0001) during follow-up when compared to RIME.

CONCLUSIONS: While both GMB and RIME cohorts showed increase in all-cause and migraine-related total costs over time, the magnitude of cost increase was significantly lower in GMB during the 1-year follow-up.