OBJECTIVES: The cost-effectiveness of fremanezumab for preventive treatment of chronic (CM) and episodic migraine (EM) in patients who had responded inadequately to 2 to 4 classes of prior preventive treatments was examined, accounting for cessation of fremanezumab treatment for non-responding patients.

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 efficacy was incorporated as reduction in mean migraine days(MDs)/28days versus placebo. Patient cohorts were distributed among MD categories (0–28MDs/28days) based on mean MD levels. The CEM-estimated costs (fremanezumab acquisition and MD-related costs) and health-related-quality-of-life (MD- and treatment status–based utilities) for fremanezumab and no-treatment arms. Only background mortality was modeled. Analyses were performed on a combined CM(67%)/EM(33%) population. CM/EM patients not achieving 30%/50% reductions, respectively, in MDs/28days at 12 weeks(non-responders) stopped fremanezumab treatment. The incremental cost-effectiveness ratio (ICER) was reported as cost/quality-adjusted life-year (QALY) gained between fremanezumab and no treatment. Fremanezumab MDs/28day reductions versus placebo and 12-week non-response rates were sourced from a network meta-analysis. In the base-case analysis, fremanezumab was compared with constant no-treatment MD profiles. Fremanezumab was also compared with randomized-controlled trial (RCT)-sourced placebo-arm MD profiles.

RESULTS: In base-case, 10-year analysis time horizon, fremanezumab treatment dominates no treatment (less costly, more effective): average cost savings, $3,492/patient; incremental QALYs, 0.22; and reduction in MDs, 161.5MDs. Excluding indirect costs, fremanezumab treatment resulted in a cost/QALY ICER of $13,606, with average incremental costs of $2,998/patient. When placebo effects were included, fremanezumab treatment dominates no treatment (less costly, more effective): average cost savings, $13,905/patient; incremental QALYs, 0.412; and reduction in MDs, 353.9MDs.

CONCLUSIONS: Based on current pricing and RCT results, fremanezumab treatment is cost-effective versus no treatment, especially if treatment is discontinued at 12 weeks for non-responders, as defined in the analysis.