OBJECTIVES: Fremanezumab is indicated for the prevention of migraine in adults in both chronic migraine (CM) and episodic migraine (EM). There remains some debate around where fremanezumab should be positioned in the treatment pathway for migraine, and so this study investigated the cost-effectiveness of fremanezumab following two inadequate treatment responses (failures) on other migraine preventive treatments.

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 full patient population of the FOCUS clinical trial (NCT03308968). The following main assumptions were used: 10-year time horizon; non-responder patients (those with<30%[CM]/50%[EM] reduction in MMDs) stop treatment after 12-week trial; 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 the comparator in this analysis, as insufficient data were available to allow a network-meta analysis comparison to onabotulinumtoxinA.

RESULTS: In CM, fremanezumab has an incremental cost-effectiveness ratio (ICER) value of £13,062/quality-adjusted life-year (QALY) and of £19,174/QALY versus BSC in EM. Sensitivity analyses showed the model was robust to changes in main inputs and was most sensitive to changes in fremanezumab drug acquisition cost, baseline monthly migraine days, analysis timeframe, and discontinuation rates. In probabilistic analyses (1,000 replications) fremanezumab was highly likely to be cost-effective at a willingness-to-pay threshold of £30,000/QALY.

CONCLUSIONS: Fremanezumab has been found to be cost-effective after previous inadequate response to two or more previous migraine preventive treatments.