OBJECTIVES

Cost-effectiveness modelling for migraine preventive therapies such as fremanezumab relies on some uncertain assumptions. During NICE appraisals, long-term stopping of treatment and appropriate time horizon were identified as impactful and uncertain inputs. This study aimed to investigate the impact of altering these assumptions within the fremanezumab cost-effectiveness model.

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) for those who had failed ≥3 previous preventive treatments. The following main assumptions were used: 10-year time horizon; non-responder patients stop treatment after 12-weeks; annual positive stopping for 20% of currently treated patients; 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 chronic migraine (CM) and episodic migraine (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

With a lifetime horizon, fremanezumab has incremental cost-effectiveness ratio (ICER) values of £4,328/quality-adjusted life-year (QALY) versus best supportive care (BSC) and £6,163/QALY versus onabotulintumtoxinA in CM (compared to £11,880/QALY versus BSC and £16,716/QALY versus onabotulinumtoxinA with 10-year horizon); with an ICER of £5,611 in EM (compared to £14,408/QALY with 10-year horizon). Without consideration of positive stopping, the ICER increased to £17,059/QALY versus BSC and £25,033/QALY versus onabotulintumtoxinA in CM; with an ICER of £20,761 in EM.

CONCLUSIONS

Under all analyses conducted fremanezumab was cost effective, which shows that fremanezumab is cost-effective in England under a variety of plausible modelling scenarios as considered by NICE.