Cost-Consequence Analysis of Fremanezumab Treatment in Patients With Migraine and Comorbid Major Depressive Disorder in the UK Using Results From the UNITE Study

OBJECTIVES: Migraine and comorbid major depressive disorder (MDD) are associated with substantial economic burden. Fremanezumab, a monoclonal antibody (mAb) targeting calcitonin gene-related peptide (CGRP), is approved for episodic and chronic migraine prevention. In the Phase 3, randomised, controlled UNITE study (NCT04041284), conducted in patients with migraine and comorbid MDD, treatment with fremanezumab resulted in significant improvements in migraine and depressive symptoms versus placebo. This analysis aimed to estimate the potential economic impact of the results from UNITE from a UK societal perspective.

METHODS: An Excel based cost-consequence model, with a 1-year time-horizon, was developed to estimate cost savings for patients with migraine and MDD when CGRP pathway mAbs are impacting only migraine outcomes (base case scenario) versus when fremanezumab is impacting both migraine and MDD outcomes (alternate scenario). Patients included in the model were aged ≥18 years and eligible for CGRP pathways mAbs. Current UK CGRP pathway mAb market shares were used (fremanezumab: 48%; other CGRP pathway mAbs: 52%). Drug and administration costs were obtained from UK public sources (MIMS UK and the National Schedule of National Health Service [NHS] costs). Healthcare utilisation, and work productivity and impairment were obtained from the 2022 EU and UK National Health and Wellness Survey (NHWS), and their respective costs were estimated. Sensitivity analyses were performed on the base case scenario.

RESULTS: Treating patients with migraine and MDD with fremanezumab is likely to be associated with reduced direct and indirect costs. Total annual cost savings of £1,155,277 were estimated for a population of 100 patients with migraine and MDD based on the existing market share of fremanezumab.

CONCLUSIONS: In patients with both migraine and MDD, treatment with fremanezumab can result in substantial direct and indirect cost savings from a UK societal perspective. These results may be of interest to clinicians and healthcare decision makers.