OBJECTIVES: Fremanezumab and onabotulinumtoxinA are treatments for the prevention of migraine in adults. In UK clinical practice, onabotulinumtoxinA is routinely used for chronic migraine (CM) patients following inadequate response to three or more previous oral preventive therapies. This study aimed to investigate the cost-effectiveness of fremanezumab in UK CM patients with an inadequate treatment response to onabotulinumtoxinA.

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 derived from the FOCUS clinical trial (NCT03308968) for patients who had previously had inadequate response onabotulinumtoxinA. The following main assumptions were used: 10-year time horizon; non-responder patients stop treatment after 12-week trial (those with <30%[CM]/50%[EM] reduction in MMDs); 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 used as the comparator.

RESULTS: In CM, fremanezumab has an incremental cost-effectiveness ratio (ICER) value of £11,471/quality-adjusted life-year (QALY) vs best supportive care (BSC). Sensitivity analyses showed the model was robust to changes in the main inputs and was most sensitive to changes in fremanezumab drug acquisition cost, response rates, baseline monthly migraine days, and fremanezumab discontinuation rates. Probabilistic analyses resulted in fremanezumab being cost-effective at a willingness-to-pay threshold of £30,000/QALY.

CONCLUSIONS: Fremanezumab is cost-effective in UK patients who have previously failed onabotulinumtoxinA therapy. This demonstrates that fremanezumab is a cost-effective treatment option for the large population of CM patients that have had an inadequate treatment response to onabotulinumtoxinA.