Presentation (CTI)

OBJECTIVES: Migraine is a common neurological condition affecting over 37 million people in the U.S., leading to significant functional impairments and high healthcare costs. Recently, calcitonin gene-related peptide (CGRP) receptor antagonists, including rimegepant and zavegepant, have emerged as effective acute migraine treatments, with zavegepant being the first non-oral gepant. This study evaluates the cost-effectiveness of zavegepant compared with rimegepant for the acute treatment of migraine in adults, using a U.S. payer perspective.
METHODS: To simulate migraine treatment outcomes, we developed a four-state Markov model with a 48-hour cycle length and a two-year time horizon. Transition probabilities were derived from clinical trials, and utility values of the four health states were derived from published literature. Costs, including drug costs and non-drug healthcare costs, were derived from IBM® Micromedex® RED BOOK® and published literature. Costs were measured in 2024 dollars. Both costs and health outcomes were discounted at 0.02% per 48 hours. We calculated the incremental cost-effectiveness ratio (ICER) and compared it with the willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) gained. One-way sensitivity analysis was conducted to assess the impact of key parameters on the ICER.
RESULTS: Zavegepant and rimegepant resulted in the same life-years, as acute migraine treatment was assumed not to affect mortality. However, zavegepant resulted in 0.016 higher QALY and an incremental cost of $1,115. The ICER for zavegepant versus rimegepant was $67,941 per QALY gained, below the threshold of $100,000 per QALY gained, indicating cost-effectiveness. Sensitivity analyses showed that the ICER was highly influenced by utility values of health states with migraine and treatment discontinuation rates.
CONCLUSIONS: Zavegepant is cost-effective compared with rimegepant for the acute treatment of migraine under the threshold of $100,000 per QALY gained.