OBJECTIVES: Erenumab and fremanezumab, calcitonin gene-related peptide (CGRP) inhibitors for the prevention of chronic and episodic migraine, demonstrated a reduction in migraine days per month and acute medication use compared to placebo. In this analysis, the cost-effectiveness of CGRP inhibitors was assessed compared to no preventive treatment for patients with chronic and episodic migraines for whom other preventive medications had failed.

METHODS: Semi-Markov models of chronic and episodic migraine were developed using time-dependent efficacy estimates from network meta-analyses of clinical trial results and mortality rates to estimate quality-adjusted life years (QALYs) and direct medical costs. The analysis used a 3% discount rate per year for both costs and outcomes from a United States health sector perspective over a two-year time horizon. One-way sensitivity and probabilistic analyses were performed. Also, two scenario analyses were performed: 1) inclusion of productivity loss 2) comparison against currently available preventive migraine treatment in all patients.

RESULTS: For patients with chronic migraine, the incremental cost-effectiveness ratio (ICER) was $90,000/QALY for erenumab and $120,000/QALY for fremanezumab. For episodic migraine patients, the ICER was $150,000/QALY for both erenumab and fremanezumab. With the inclusion of productivity effects, the ICER for patients with chronic migraine was $50,000/QALY for erenumab and $110,000/QALY for fremanezumab, and the ICER for patients with episodic migraine was $80,000/QALY for erenumab and $110,000/QALY for fremanezumab. Relative to currently available preventive migraine treatments, all ICERs were well above $300,000/QALY.

CONCLUSIONS: At currently expected discounted prices, erenumab and fremanezumab are projected to have ICERs under $150,000/QALY for chronic migraine patients for whom existing treatment has failed, but at or above $150,000/QALY for episodic migraines. The inclusion of productivity effects for CGRPs resulted in more favorable ICERs, but CGRP inhibitors relative to currently available therapies for all potential patients are projected to have ICERs greatly exceeding current willingness-to-pay thresholds.