OBJECTIVES

Fremanezumab is indicated for the prevention of migraine in adults, including both chronic migraine (CM) and episodic migraine (EM). Clinical practice within England positions fremanezumab after inadequate response to three other preventive treatments. This study aimed to investigate the cost-effectiveness of fremanezumab from the NHS perspective in England.

METHODS

A semi-Markov cost-economic model that distributed patients across monthly migraine day (MMD) states (0-28 MMDs) was populated with efficacy and patient baseline data from the FOCUS clinical trial (NCT03308968). In the base case the framework of the NICE reference case was utilised with the following main assumptions: 10-year time horizon; non-responder patients (those with<30%[CM]/50%[EM] reduction in MMDs) stop treatment after 12-week trial; positive stopping occurred for 20% of currently treated patients annually; healthcare resource use from National Health and Wellness Survey; costs from NHS reference costs and British National Formulary (2019 prices); utilities from FOCUS trial Migraine-Specific Quality Of Life; and discounting at 3.5%. Best supportive care (acute migraine treatment only, modelled using FOCUS placebo data) was a comparator for CM and EM, whilst onabotulinumtoxinA was only a comparator for CM (due to its licensed indication; efficacy data derived from network meta-analysis); hence separate analyses were conducted for CM and EM.

RESULTS

In CM, fremanezumab (at UK list price) has incremental cost-effectiveness ratio (ICER) values of £11,880/quality-adjusted life-year (QALY) versus best supportive care (BSC) and £16,716 versus onabotulinumtoxinA. In EM, ICER for fremanezumab was £14,408/QALY versus BSC. Sensitivity analyses showed the model was robust to changes in main inputs and was most sensitive to changes in fremanezumab cost, response rates, initial MMDs, and analysis timeframe. Probabilistic analyses resulted in fremanezumab being cost-effective at a willingness-to-pay threshold of £30,000/QALY.

CONCLUSIONS

Using the England NHS perspective, this study concluded that fremanezumab is a cost-effective treatment when compared with BSC and onabotulinumtoxinA.