BACKGROUND: Two oral Calcitonin gene-related peptide (CGRP) inhibitors, atogepant and rimegepant, were approved by the FDA for prevention of episodic migraine (EM) in adults. Uncertainties remain regarding the effectiveness of atogepant compared with rimegepant, and how well the cost of atogepant will align with patient benefits.

OBJECTIVES: This research aims to estimate the incremental cost-effectiveness of atogepant compared to rimegepant in adults with episodic migraine prophylaxis.

METHODS: A Markov model with three health states (on treatment, off treatment, and death) and a 4-week cycle was used to estimate the cost and effectiveness of the intervention and the comparator over 2 years from societal perspective. Model population was adults with EM who were candidates for preventative treatment and have not failed ≥2 alternative treatments. Data on costs and health-related quality of life were derived from literature. The treatment effects are estimated based on monthly migraine day (MMD) reduction from clinical trials. One-way sensitivity and scenario analyses were conducted to assess the robustness of model findings. All costs were stated as 2022 U.S. dollars.

RESULTS: In both base case and scenario analysis, atogepant appeared to be dominant compared to rimegepant: base case total cost was $38,962 and $64,559, and the benefits were 17.11 and 17.03 QALYs, respectively. The model was most sensitive to the utility value, probability of treatment discontinuation, and drug costs.

CONCLUSIONS: Compared to rimegepant, atogepant is likely the dominant therapy for episodic migraine prevention from a societal perspective. This economic benefit appeared to be influenced by adherence, patient response, and the cost of treatment. Major limitation in this study was the difference in clinical trial population: rimegepant trial seemed to have higher MMD baseline compared to atogepant. Future research in different utility values and probabilistic sensitivity analysis is recommended.