NOVEL BIOLOGICS VERSUS CONVENTIONAL PREVENTIVE THERAPIES IN MIGRAINE- A FRAMEWORK FOR ECONOMIC EVALUATION
Author(s)
Lipton RB1, Brennan A2, Palmer S3, Jansen JP4, Hatswell AJ5, Porter JK6, Di Tanna GL6, Villa G6, Shah N7, Sapra S7
1Albert Einstein College of Medicine, Bronx, NY, USA, 2University of Sheffield, Sheffield, UK, 3University of York, Heslington, York, UK, 4Precision Health Economics, Los Angeles, CA, USA, 5BresMed Health Solutions, Sheffield, UK, 6Amgen (Europe) GmbH, Zug, Switzerland, 7Amgen Inc, Thousand Oaks, CA, USA
OBJECTIVES: Erenumab, a calcitonin gene-related peptide receptor inhibitor (CGRPRi) developed for the prevention of migraine, has completed phase 3 studies. The goal of healthcare policy makers is to position this novel class of therapy to maximise the clinical and economic benefits in this highly prevalent and burdensome disease. We propose an economic modelling framework to assess the cost-effectiveness of CGRPRi in migraine prevention. METHODS: We reviewed previous economic models of migraine preventives, assessed how well they represented outcomes of migraine patients and summarized key limitations. We then constructed a de novo semi-Markov health state transition model, driven by clinical literature and expert opinion. RESULTS: Previous models differed in structure and clinical endpoints used. A common limitation was the aggregation of migraine frequency data into simplified health states based on response status or arbitrarily-defined categories of frequency. The proposed framework models the frequency of migraine days per 28 days (monthly migraine days [MMD]) as a continuous outcome, from which patient costs and quality-adjusted life-years are estimated. Patient-level variation in MMD is modelled assuming negative binomially and beta-binomially distributed panel data, to facilitate parametric indirect comparisons. Current preventives in migraine are associated with significant tolerability issues, therefore the model applies time- and treatment-specific discontinuation rates to account for the role of patient adherence in assessing cost-effectiveness. Utilities are modelled as a function of MMD, using EQ-5D values mapped from migraine specific instruments. In addition to drug acquisition and administration costs, medical resource use, acute medication use and productivity losses are also estimated, all of which are linked to MMD frequency. CONCLUSIONS: By adapting previous modelling approaches based on expert opinion, we developed a modelling framework to assess the cost-effectiveness of novel preventive biologics in episodic and chronic migraine. By modelling migraine frequency as a continuous outcome, we address a key limitation of previous approaches.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PRM12
Topic
Clinical Outcomes, Economic Evaluation, Methodological & Statistical Research, Study Approaches
Topic Subcategory
Clinical Outcomes Assessment, Confounding, Selection Bias Correction, Causal Inference, Cost/Cost of Illness/Resource Use Studies, Modeling and simulation, PRO & Related Methods
Disease
Neurological Disorders
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