OBJECTIVES: Erenumab is a new preventive treatment for chronic migraine (CM) which has not yet been priced in Greece. This study evaluated the costs and outcomes of erenumab as a first-line preventative treatment for CM in Greece, compared to topiramate (TPM), an antiepileptic drug often used for CM, focusing on erenumab price thresholds required to attain cost-effectiveness benchmarks.

METHODS: A decision-tree model was used to project costs and outcomes, expressed as migraines avoided and as quality-adjusted life years (QALYs), from both a payer and societal perspective. The time-horizon was one year and all costs were calculated in 2018 euros (€). Sensitivity analyses assessed the impact of parameter uncertainty on model results.

RESULTS: From an initial state of no treatment, treatment with erenumab resulted in a reduction of 12 additional migraines per year compared to the reduction for TPM. Using an erenumab price of €203/month (estimated from past pricing of analogous drugs in Greece relative to the US price of $575/month), the estimated incremental cost-effectiveness ratio (ICER) was €171 per migraine avoided and €186,813 per QALY gained, from a payer’s perspective. Accounting for both medical and non-medical costs (societal perspective), the ICERs were €163.7 per migraine avoided and €178,541 per QALY gained. Using a common existing cost-effectiveness threshold equal to three times local GDP per capita (€49,000 for Greece), for the erenumab ICER fall below this threshold, the erenumab price would have to be no more than €75 (payer perspective) or €83 (societal perspective). However, model results indicated that erenumab, as a second-line treatment for patients who fail TPM treatment, might be considered cost-effective at the €203/month price, with an ICER of €36,760 (payer perspective).

CONCLUSIONS: Erenumab might be cost-effective as a first-line preventative treatment of CM in Greece, but only at a highly reduced price compared to the US price.