Cost-Effectiveness of Eptinezumab for Preventing Migraines

OBJECTIVES: Migraine affects millions of people in Taiwan. The emergence of CGRP (calcitonin gene-related peptide) drugs, including eptinezumab, has provided significant advancements in the treatment and prevention of migraines. However, these drugs are expensive and economic evaluations are scarce. This study aims to evaluate the cost-effectiveness of eptinezumab for migraine prevention.

METHODS: The cost-effectiveness of eptinezumab versus placebo for migraine prevention was evaluated using a Markov model with a 6-month time horizon. Clinical and economic outcomes were simulated from a societal perspective using parameters from clinical trials and literature. Patients were categorized into six groups based on monthly migraine days (MMDs). Results were presented as the incremental cost per quality-adjusted life year (QALY) gained. The willingness-to-pay (WTP) threshold was set at one gross domestic product (GDP) per capita ($32,327) in 2023.Point estimates for the incremental cost-effectiveness ratio (ICER) were calculated using a Monte Carlo simulation of 10,000 iterations. Deterministic and probabilistic sensitivity analyses were performed to handle uncertainties.

RESULTS: Over the six-month time horizon, eptinezumab cost $6,453 versus $3,617 for placebo, with QALY gains of 1.40 and 1.22, respectively, resulting in an ICER of $15,475. The deterministic sensitivity analysis showed that the utility of taking eptinezumab for patients with 4-9 MMDs had the most significant impact on the ICER, raising it to around $22,000. At the WTP threshold of $32,327, eptinezumab was cost-effective under 98% of iterations.

CONCLUSIONS: Eptinezumab demonstrates potential cost-effectiveness in migraine prevention in Taiwan context. The utility of patients using eptinezumab is the most significant factor affecting the ICER, highlighting the need for more reliable data.