Cost-Utility Analysis of Migraine Prevention Treatments for Chronic Migraine Headaches Patients in the United States
Author(s)
Weiming (Ariel) Dong, B.S., Mark Bounthavong, MPH, PharmD, PhD;
University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
Presentation Documents
OBJECTIVES: To evaluate the cost-effectiveness of migraine prevention treatments in patients with chronic migraine
METHODS: A hybrid decision-Markov model was constructed to evaluate the cost-effectiveness of prevention medications (eptinezumab, erenumab, and onabotulinumtoxinA) for chronic migraine. The decision tree model simulated probabilities of a hypothetical cohort of patients who achieved more than 50% reduction in monthly migraine days within the first 6 months of each treatment. Patients only remained on treatment if they experienced a clinical response. The Markov model then simulated costs and quality-adjusted life years (QALY) over a 10-year horizon. The medication costs were derived from U.S. Department of Veterans Affairs (VA) Federal Supply Schedule. Transition probabilities and utility scores were based on existing literature. Results were presented as total costs, QALYs, incremental cost per QALY gained (ICER) of all three interventions. Cost-effectiveness frontier was used to eliminate the strategy that was not cost-effective. A probabilistic sensitivity analysis with 10,000 iterations was performed to test the robustness of the findings. A cost-effectiveness acceptability curve was generated to illustrate the probability of each strategy being cost-effective at various willingness to pay (WTP) thresholds.
RESULTS: In the base-case analysis, the total costs of eptinezumab, erenumab, and onabotulinumtoxinA were $107,209, $124,225, and $103,607, respectively, and total QALYs of those three interventions were 4.78, 4.54, and 4.20, respectively. Erenumab was excluded from the cost-effectiveness frontier since it was associated with lower QALYs and higher total costs than eptinezumab. Base-case ICER of eptinezumab compared to onabotulinumtoxinA was $6,319 per QALY gained. In the PSA results, eptinezumab was cost-effective in 99.3% of the simulations compared to onabotulinumtoxinA with a WTP threshold of $50,000 per QALY gained.
CONCLUSIONS: Eptinezumab was a cost-effective strategy at a WTP of $50,000 per QALY gained compared to onabotulinumtoxinA. However, onabotulinumtoxinA may be an alternative cost-effective option if eptinezumab was not tolerated by the patient.
METHODS: A hybrid decision-Markov model was constructed to evaluate the cost-effectiveness of prevention medications (eptinezumab, erenumab, and onabotulinumtoxinA) for chronic migraine. The decision tree model simulated probabilities of a hypothetical cohort of patients who achieved more than 50% reduction in monthly migraine days within the first 6 months of each treatment. Patients only remained on treatment if they experienced a clinical response. The Markov model then simulated costs and quality-adjusted life years (QALY) over a 10-year horizon. The medication costs were derived from U.S. Department of Veterans Affairs (VA) Federal Supply Schedule. Transition probabilities and utility scores were based on existing literature. Results were presented as total costs, QALYs, incremental cost per QALY gained (ICER) of all three interventions. Cost-effectiveness frontier was used to eliminate the strategy that was not cost-effective. A probabilistic sensitivity analysis with 10,000 iterations was performed to test the robustness of the findings. A cost-effectiveness acceptability curve was generated to illustrate the probability of each strategy being cost-effective at various willingness to pay (WTP) thresholds.
RESULTS: In the base-case analysis, the total costs of eptinezumab, erenumab, and onabotulinumtoxinA were $107,209, $124,225, and $103,607, respectively, and total QALYs of those three interventions were 4.78, 4.54, and 4.20, respectively. Erenumab was excluded from the cost-effectiveness frontier since it was associated with lower QALYs and higher total costs than eptinezumab. Base-case ICER of eptinezumab compared to onabotulinumtoxinA was $6,319 per QALY gained. In the PSA results, eptinezumab was cost-effective in 99.3% of the simulations compared to onabotulinumtoxinA with a WTP threshold of $50,000 per QALY gained.
CONCLUSIONS: Eptinezumab was a cost-effective strategy at a WTP of $50,000 per QALY gained compared to onabotulinumtoxinA. However, onabotulinumtoxinA may be an alternative cost-effective option if eptinezumab was not tolerated by the patient.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE415
Topic
Economic Evaluation
Disease
SDC: Neurological Disorders, STA: Biologics & Biosimilars