Economic Evaluation of Atogepant vs. Placebo for the Preventive Treatment of Episodic Migraine in Taiwan
Author(s)
CHING-YUAN FANG, PharmD1, Ping-Hsuan Hsieh, PhD2, Fu-Chi Yang, MD, PhD3.
1National Defense Medical Center, Taipei city, Taiwan, 2National Defense Medical Center, Taipei City, Taiwan, 3Tri-Service General Hospital, Taipei city, Taiwan.
1National Defense Medical Center, Taipei city, Taiwan, 2National Defense Medical Center, Taipei City, Taiwan, 3Tri-Service General Hospital, Taipei city, Taiwan.
OBJECTIVES: Migraine affects approximately two million individuals in Taiwan, imposing a significant burden on productivity and quality of life. Atogepant, an oral calcitonin gene-related peptide (CGRP) receptor antagonist, has demonstrated preventive efficacy but comes at a higher cost than traditional therapies. This study assessed the cost-effectiveness of atogepant versus placebo for the prevention of episodic migraine in adults, from the perspective of Taiwan's National Health Insurance (NHI).
METHODS: A Markov model with 12-week cycles was constructed to evaluate the cost-effectiveness of atogepant 60 mg compared to placebo over a one-year horizon. Clinical efficacy data were sourced from the Phase III ADVANCE trial. Drug acquisition costs were based on list prices reported in the NICE appraisal, while other healthcare costs were derived from Taiwanese literature. Utility values were obtained from published sources. Outcomes included the number of migraine days avoided, total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses, including one-way and probabilistic approaches, were conducted to assess model robustness.
RESULTS: Over one year, atogepant reduced migraine days by 55 days compared to 30.6 days with placebo. The incremental QALY gain was 0.027 and an additional cost of $1,768, resulting an ICER of $65,894. Atogepant was considered cost-effective under a willingness-to-pay (WTP) threshold of one to three times Taiwan’s GDP per capita. Sensitivity analyses identified utility values as the most influential parameter. The probability of atogepant being cost-effective exceeded 50% when the WTP threshold surpassed $83,808 and plateaued around 60%.
CONCLUSIONS: Atogepant appears cost-effective for episodic migraine prevention in Taiwan under conservative acquisition-price assumptions. Nevertheless, longer-term effectiveness data and real-world utility measurements are needed to further reduce decision uncertainty.
METHODS: A Markov model with 12-week cycles was constructed to evaluate the cost-effectiveness of atogepant 60 mg compared to placebo over a one-year horizon. Clinical efficacy data were sourced from the Phase III ADVANCE trial. Drug acquisition costs were based on list prices reported in the NICE appraisal, while other healthcare costs were derived from Taiwanese literature. Utility values were obtained from published sources. Outcomes included the number of migraine days avoided, total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses, including one-way and probabilistic approaches, were conducted to assess model robustness.
RESULTS: Over one year, atogepant reduced migraine days by 55 days compared to 30.6 days with placebo. The incremental QALY gain was 0.027 and an additional cost of $1,768, resulting an ICER of $65,894. Atogepant was considered cost-effective under a willingness-to-pay (WTP) threshold of one to three times Taiwan’s GDP per capita. Sensitivity analyses identified utility values as the most influential parameter. The probability of atogepant being cost-effective exceeded 50% when the WTP threshold surpassed $83,808 and plateaued around 60%.
CONCLUSIONS: Atogepant appears cost-effective for episodic migraine prevention in Taiwan under conservative acquisition-price assumptions. Nevertheless, longer-term effectiveness data and real-world utility measurements are needed to further reduce decision uncertainty.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE374
Topic
Economic Evaluation
Disease
Neurological Disorders