ACCESS TO CALCITONIN GENE RELATED PEPTIDE ANTAGONISTS FOR MIGRAINE IN LITHUANIA
Author(s)
Kristina Garuoliene, PhD1, Nomeda Bratcikoviene, PhD2, Liubove Murauskiene, PhD1.
1Faculty of Medicine, Vilnius University, Vilnius, Lithuania, 2Department of Mathematical Statistics, Faculty of Fundamental Sciences, Vilnius Tech, Vilnius, Lithuania.
1Faculty of Medicine, Vilnius University, Vilnius, Lithuania, 2Department of Mathematical Statistics, Faculty of Fundamental Sciences, Vilnius Tech, Vilnius, Lithuania.
OBJECTIVES: To evaluate access to calcitonin gene-related peptide (CGRP) antagonists among migraine patients in Lithuania.
METHODS: The population-wide cross-sectional study used administrative data from the National Health Insurance Fund, Social Insurance, Tax Inspectorate, and State Data Agency to evaluate patients dispensed innovative CGRP-targeted migraine therapy in 2023 to a reference population of income-declaring residents. Patients dispensed CGRP antagonists were classified into clusters using k-means analysis based on demographic, territorial, and socioeconomic characteristics. Cluster 1 comprised predominantly older and lower-income patients, whereas Cluster 2 comprised primarily working-age, higher-income patients. Associations between cluster membership and municipality were assessed using a chi-square test, with Cramer's V used to estimate the strength of association. Standardized residuals were examined to identify municipalities with significant over- or under- representation of specific clusters. Differences in cluster distribution between the patient's cohort and the reference population were evaluated using Pearson's chi-square test with Yates continuity correction.
RESULTS: We identified 572 patients who were dispensed CGRP antagonists: 95 in Cluster 1 and 477 in Cluster 2. Cluster membership showed a moderate association with the municipality of residence (Cramer's V=0.34), indicating territorial heterogeneity in access to innovative migraine treatment. Cluster 1 (lower-income, older patients) was significantly underrepresented in several municipalities (standardized residuals >2). The distribution of Clusters 1 and Clusters 2 differed significantly between patients treated with CGRP antagonists and the general income-declaring population (X2 = 27.547, p<0.001), suggesting structural demographic and socioeconomic differences between these populations.
CONCLUSIONS: Territorial and socioeconomic patterns in the distribution of patient clusters indicate potential inequities in access to CGRP antagonist therapy among migraine patients in Lithuania. Policy efforts should extend beyond positive reimbursement decisions to include systematic monitoring of real-world data and targeted measures to promote equitable diffusion of innovative migraine therapy across municipalities and socioeconomic groups.
METHODS: The population-wide cross-sectional study used administrative data from the National Health Insurance Fund, Social Insurance, Tax Inspectorate, and State Data Agency to evaluate patients dispensed innovative CGRP-targeted migraine therapy in 2023 to a reference population of income-declaring residents. Patients dispensed CGRP antagonists were classified into clusters using k-means analysis based on demographic, territorial, and socioeconomic characteristics. Cluster 1 comprised predominantly older and lower-income patients, whereas Cluster 2 comprised primarily working-age, higher-income patients. Associations between cluster membership and municipality were assessed using a chi-square test, with Cramer's V used to estimate the strength of association. Standardized residuals were examined to identify municipalities with significant over- or under- representation of specific clusters. Differences in cluster distribution between the patient's cohort and the reference population were evaluated using Pearson's chi-square test with Yates continuity correction.
RESULTS: We identified 572 patients who were dispensed CGRP antagonists: 95 in Cluster 1 and 477 in Cluster 2. Cluster membership showed a moderate association with the municipality of residence (Cramer's V=0.34), indicating territorial heterogeneity in access to innovative migraine treatment. Cluster 1 (lower-income, older patients) was significantly underrepresented in several municipalities (standardized residuals >2). The distribution of Clusters 1 and Clusters 2 differed significantly between patients treated with CGRP antagonists and the general income-declaring population (X2 = 27.547, p<0.001), suggesting structural demographic and socioeconomic differences between these populations.
CONCLUSIONS: Territorial and socioeconomic patterns in the distribution of patient clusters indicate potential inequities in access to CGRP antagonist therapy among migraine patients in Lithuania. Policy efforts should extend beyond positive reimbursement decisions to include systematic monitoring of real-world data and targeted measures to promote equitable diffusion of innovative migraine therapy across municipalities and socioeconomic groups.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR180
Topic
Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Health Disparities & Equity, Reimbursement & Access Policy
Disease
Biologics & Biosimilars, Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas