OBJECTIVES: Fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene-related peptide, is approved for preventive treatment of migraine in adults. Its cost-effectiveness compared to no treatment for prevention of chronic migraine (CM) and episodic migraine (EM) was examined in patients who had responded inadequately to 2 to 4 classes of prior preventive treatments.

METHODS: A semi-Markov cost-effectiveness model (CEM) was developed with a 4-week cycle and 10-year analysis time horizon. Costs and benefits were discounted at 3.0% annual rates. Treatment efficacies were incorporated as reductions in mean migraine days (MDs)/28-days versus placebo. Patient cohorts were distributed among MD categories (0–28 MDs/28-days) based on mean MD levels. The CEM estimated costs (fremanezumab acquisition costs, MD-related costs [direct and indirect]) and health-related quality-of-life (MD- and treatment status-based utilities) for fremanezumab and no-treatment arms. Only background mortality was modeled. Outcome measures were costs, reduction in MDs, and quality-adjusted life-years (QALYs). Analyses were performed on a combined CM(67%)/EM(33%) population. The incremental cost-effectiveness ratios (ICERs) were reported as cost/QALY gained between fremanezumab and no treatment. Fremanezumab MDs/28-day reductions versus placebo were sourced from a Network Meta-Analysis (NMA). In the base-case versus no-treatment analysis, fremanezumab was compared with constant no-treatment MD profiles. Fremanezumab was also compared with randomized clinical trial (RCT)-sourced placebo-arm MD profiles.

RESULTS: In the base-case versus no-treatment 10-year analysis time horizon, fremanezumab treatment resulted in cost/QALY ICER of $31,998; average incremental costs, $5,893/patient; incremental QALYs, 0.184; and reduction in MDs,107.0 MDs. Excluding indirect costs, fremanezumab treatment resulted in a cost/QALY ICER of $55,850; average incremental costs, $10,285/patient. Including placebo effects, fremanezumab treatment resulted in a cost/QALY ICER of $48,925; average incremental costs, $7,650/patient; incremental QALYs, 0.156, and reduction in MDs, 83.6 MDs.

CONCLUSIONS: Based on current pricing and RCT results, fremanezumab treatment is cost effective versus no treatment.