OBJECTIVES: There is a need for innovative, cost-effective and affordable drugs to treat migraine patients who have failed previous oral preventive treatments. We aimed to estimate cost-effectiveness of erenumab 140 mg (“erenumab”) in the prevention of migraine in adults with three or more previous preventive treatment failures (TF3+) in Portugal, comparing health benefits and costs to placebo.

METHODS: Hybrid decision-tree and Markov model with a 12-week cycle to estimate costs and health benefits in Portugal from the societal and NHS perspectives considering a lifetime horizon (60 years). Data inputs obtained from published literature, official data sources and placebo-controlled randomized trials of erenumab in episodic/chronic migraine. Base-case assumptions were validated by an independent local expert panel (including treatment stopping rules). Health benefits were measured as quality-adjusted life years (QALYs) and migraine days. Direct costs included drug utilization/administration, and disease management (consultations, emergency, hospitalization, exams). Indirect costs included work presenteeism and absenteeism. Costs were expressed in 2019 Euro (€). Health-effects and costs were accumulated over the lifetime horizon to estimate the incremental cost-effectiveness ratio (ICER). Benefits and costs were annually discounted at 5%. Sensitivity analyses were performed.

RESULTS: In the societal perspective, preventing migraine with erenumab results in 0.28 gained QALYs (undiscounted: 0.60 QALYs) and a total of 255 migraine days avoided (undiscounted: 678 migraine days avoided) versus placebo over a lifetime horizon. Model estimates that benefits are achieved at a lower cost, meaning that erenumab is dominant (more effective and cost-saving) versus placebo. Considering the Portuguese NHS perspective, erenumab is cost-effective with a cost per gained QALY considerably below €20,000. The model results were more sensitive to treatment stopping rules.

CONCLUSIONS: Erenumab is predicted to generate savings to society and increased QALYs compared to no preventive treatment. It is a cost-effective approach to preventing migraine days among adults TF3+ in Portugal versus no preventive treatment.