OBJECTIVES: Cost-utility modeling informs reimbursement decisions and is based on the premise that health outcome improvements can be expressed as disease-independent utility scores. Previous cost-utility analyses of anti-calcitonin gene-related peptide therapies expressed the utility gain as a function of monthly migraine days (MMDs). Exploring the presence of an additional treatment effect on utility after controlling for MMDs can be insightful. This post hoc analysis of the DELIVER clinical trial (NCT04418765) for the preventive treatment of migraine aims to communicate the impact of eptinezumab on health utility scores.

METHODS: Utility scores were estimated using data from study visits at which the Migraine-Specific Quality of Life Questionnaire (MSQ) was completed. MSQ scores were then mapped to EQ-5D-3L using previously published algorithms. A linear mixed model evaluating the effect of eptinezumab compared to placebo using change from baseline at week 12 and 24, adjusted for MMDs, was generated, and a fixed intercept for each study arm was used to estimate if eptinezumab effected points compared to placebo beyond MMD reduction.

RESULTS: Analysis (n=1698 observations) of patients’ change from baseline in utility (Weeks 1‒24) revealed that a strong eptinezumab treatment effect relative to placebo was observed, with the combined impact resulting in a gain of 0.09 points for eptinezumab compared to placebo (P<0.001). Score improvements were similar for eptinezumab 100 and 300 mg. After controlling for number of MMDs, eptinezumab patients had an additional utility increment of 0.056 (95% CI: 0.0382‒0.0742) relative to placebo patients.

CONCLUSIONS: On average, patients treated with eptinezumab in DELIVER had a higher utility score than placebo patients, which is partially driven by the larger MMD reduction with eptinezumab treatment. However, these results also suggest that a treatment-specific utility impact exists in addition to MMD reduction. MMD reduction is not the sole driver of score improvement in migraine patients.