Presentation (CTI)

OBJECTIVES: Like many other industrialised economies, Norway faces increasing pressure to sustain workforce participation in the coming decades due to demographic changes. At the same time, productivity effects of new pharmaceutical interventions are not considered in healthcare priority setting. This affects prioritisation and may have wider implications, especially in relation to diseases like migraine with its high prevalence among individuals in working age. This study assessed the cost-effectiveness of rimegepant compared with standard of care (SoC) in the preventive treatment of adults with episodic migraine and prior preventive treatment failure, with particular focus on the contribution of productivity gains.
METHODS: A decision tree plus Markov model was developed to estimate clinical and labour market outcomes, costs, and quality-adjusted life-years (QALYs) over a 20-year horizon from a societal perspective. Key inputs, including monthly migraine days, responder rates (≥50% reduction in monthly migraine days), and QALYs were informed by the BHV3000-407 trial. Scenario analyses explored uncertainty surrounding productivity gains by assuming that only 75%, 50%, or 25% of estimated gains were realised.
RESULTS: Rimegepant was the dominant treatment option, being associated with both cost savings and health gains when compared with SoC. Results were robust to conservative assumptions regarding productivity benefits. Rimegepant remained dominant when only 75%, 50%, and 25% of estimated productivity gains were assumed to be realised. Excluding gains from unpaid work, rimegepant remained associated with lower costs and greater health gains when only 47% of the predicted productivity gains were realised.
CONCLUSIONS: In conditions such as migraine, disease burden falls heavily on the working-age population. Excluding productivity effects from economic evaluations will underestimate the broader societal benefit of effective treatment. These findings highlight the need for an updated discussion on the role of productivity effects in healthcare priority setting, particularly in ageing societies facing workforce shortages.