OBJECTIVES: Galcanezumab (Emgality®) and fremanezumab (Ajovy®) are subcutaneous (SC) monoclonal antibodies (mAbs) against calcitonin gene-related peptide (CGRP) indicated in chronical migraine treatment. They are not covered by the French national health insurance (NHI) but are available in retail pharmacies (around €250 per month) at the patient’s expense. Eptinezumab (Vyepti®) is a new costly intravenous anti-CGRP that is only available for inpatients, implying hospital-supported costs.

This study aims to determine the financial impact of eptinezumab in French hospitals.

METHODS: The anti-CGRP mAbs costs for migraine care in hospitals were estimated using data from a French national survey on hospital treatment costs, a probable cost scenario, and the medicalized information system program (ePMSI). Medico-economic data come from a systematic review of the literature.

RESULTS: French NHI reimburses between €403 and €470 for a hospital session for migraine care, with an estimate cost of treatment around €173 allocated before eptinezumab launch. However, by taking into account the estimate price of eptinezumab per administration for a 16 800 target population, the approximate annual financial impact for hospitals could be around -16 million € per year, without considering the potential important related medical costs (for hospitalization, consultations in neurology and psychiatry, general practitioner consult, nurse care and emergency).

In addition, referencing eptinezumab might attract the patients treated by the other anti-CGRP mAbs, which might increase this economic impact.

Comparing to the other anti-CGRP mAbs, literature review shows that eptinezumab has an approximatively equal ICER. Despite this, the NICE is the only agency of United Kingdom that supports NHI coverage of this treatment, due to its ability to reduce migraine symptoms faster.

CONCLUSIONS: This case demonstrates the limits of cost-efficient drugs, which are beneficial to society, but whose costs must be supported by the hospital.