TITLE: COST-UTILITY ANALYSIS OF CALCITONIN GENE-RELATED PEPTIDE ANTIBODIES FOR PATIENTS WITH CHRONIC MIGRAINE: A UNITED STATES PAYER PERSPECTIVE
Author(s)
Steven C. Do, PharmD1, Cindy M. Chan, PharmD1, Raquel S. Erb, PharmD2, Kangho Suh, PharmD, PhD1;
1University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA, 2Baylor Scott & White Health, Temple, TX, USA
1University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA, 2Baylor Scott & White Health, Temple, TX, USA
OBJECTIVES: Migraines are debilitating neurologic condition and have a significant economic burden. The goal of this study was to evaluate the cost-effectiveness of calcitonin gene-related peptide (CGRP) monoclonal antibodies (eptinezumab, erenumab, fremanezumab, and galcanezumab) for migraine prevention in patients with chronic migraine from a U.S. payer perspective.
METHODS: A Markov model with monthly cycles and a 10-year time horizon was designed to compare CGRP monoclonal antibodies against best supportive care. The model included on- and off-treatment health states, each having a distribution of migraine-free, mild, moderate, and severe days, plus death. A published network meta-analysis of randomized controlled trials was used to derive transition probabilities and monthly migraine days for each health state. Monthly migraine days were used to estimate quality-adjusted life years (QALY), and adverse events were applied as disutility values. Drug acquisition and health state costs were estimated in 2025 U.S. dollars. Both costs and utilities were discounted at 3% annually. Incremental cost-effectiveness ratios (ICERs) were calculated, and changes in migraine-free days were assessed. Probabilistic and one-way sensitivity analyses assessed the robustness of results.
RESULTS: Compared with best supportive care, none of the CGRP monoclonal antibodies were cost-effective at a willingness-to-pay threshold of $10,000 per QALY gained. Eptinezumab, erenumab, fremanezumab, and galcanezumab resulted in ICERs of $268,801, $260,515, $118,898, and $332,404 per QALY gained respectively. fremanezumab resulted in lowest total cost ($52,524) and lowest QALY (6.44) while galcanezumab had the highest total costs ($74,538) and highest QALY (6.47). Migraine-free days gained versus best supportive care were 81.4, 84.7, 69.0, and 98.9 for eptinezumab, erenumab, fremanezumab, and galcanezumab, respectively.
CONCLUSIONS: At current prices, CGRP monoclonal antibodies were not cost-effective compared with best supportive care from a U.S. payer perspective. These findings may inform payer decision-making regarding coverage and reimbursement for chronic migraine prevention.
METHODS: A Markov model with monthly cycles and a 10-year time horizon was designed to compare CGRP monoclonal antibodies against best supportive care. The model included on- and off-treatment health states, each having a distribution of migraine-free, mild, moderate, and severe days, plus death. A published network meta-analysis of randomized controlled trials was used to derive transition probabilities and monthly migraine days for each health state. Monthly migraine days were used to estimate quality-adjusted life years (QALY), and adverse events were applied as disutility values. Drug acquisition and health state costs were estimated in 2025 U.S. dollars. Both costs and utilities were discounted at 3% annually. Incremental cost-effectiveness ratios (ICERs) were calculated, and changes in migraine-free days were assessed. Probabilistic and one-way sensitivity analyses assessed the robustness of results.
RESULTS: Compared with best supportive care, none of the CGRP monoclonal antibodies were cost-effective at a willingness-to-pay threshold of $10,000 per QALY gained. Eptinezumab, erenumab, fremanezumab, and galcanezumab resulted in ICERs of $268,801, $260,515, $118,898, and $332,404 per QALY gained respectively. fremanezumab resulted in lowest total cost ($52,524) and lowest QALY (6.44) while galcanezumab had the highest total costs ($74,538) and highest QALY (6.47). Migraine-free days gained versus best supportive care were 81.4, 84.7, 69.0, and 98.9 for eptinezumab, erenumab, fremanezumab, and galcanezumab, respectively.
CONCLUSIONS: At current prices, CGRP monoclonal antibodies were not cost-effective compared with best supportive care from a U.S. payer perspective. These findings may inform payer decision-making regarding coverage and reimbursement for chronic migraine prevention.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE248
Topic
Economic Evaluation
Disease
SDC: Neurological Disorders