Cost-Effectiveness of Erenumab for the Preventive Treatment of Migraine in Patients with Prior Treatment Failures in Sweden

TY - JOUR

T1 - Cost-Effectiveness of Erenumab for the Preventive Treatment of Migraine in Patients with Prior Treatment Failures in Sweden

AU - Mahon, Ronan

AU - Lang, Andrea

AU - Vo, Pamela

AU - Huels, Jasper

AU - Cooney, Philip

AU - Danyliv, Andriy

AU - Vudumula, Umakanth

AU - Vadapalle, Sreelatha

AU - Maniyar, Farooq

AU - Goadsby, Peter J.

N1 - Funding Information: This study was sponsored by Novartis Pharma AG. Funding Information: Ronan Mahon, Andrea Lang, Jasper Huels, Philip Cooney, Andriy Danyliv, Umakanth Vudumula, Sreelatha Vadapalle and Pamela Vo are employees of Novartis. Peter J. Goadsby has received personal fees from Alder Biopharmaceuticals, Allergan, Autonomic Technologies Inc., Biohaven Pharmaceuticals Inc., Clexio, Electrocore LLC, eNeura Inc, Impel Neuropharma, MundiPharma, Novartis, Teva Pharmaceuticals and WL Gore; grants and personal fees from Amgen and Eli Lilly and Company; a grant from Celgene; and other funding from Trigemina, all outside the submitted work; has a patent magnetic stimulation for headache licensed to eNeura without fee; and has received fees for publishing from Oxford University Press, Massachusetts Medical Society, Wolters Kluwer and fees for medico-legal work. Farooq Maniyar has received personal fees from Novartis for attending advisory board meetings, key opinion leader meetings and delivering lectures. Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/3

Y1 - 2021/3

N2 - Background: Migraine is a common neurological disease that disproportionately affects females and has a peak incidence during productive years, resulting in significant burden. Objective: The aim of the study was to determine the cost effectiveness of erenumab for the preventive treatment of migraine. Methods: A hybrid decision-tree plus Markov model was developed to evaluate the cost effectiveness of erenumab as a migraine treatment compared with best supportive care only for patients experiencing at least 4 monthly migraine days for whom at least two prior preventive treatments had failed. Clinical efficacy data were based on results from four randomized controlled trials of erenumab against placebo. The primary outcomes were costs, migraine days, and quality-adjusted life-years (QALYs). An incremental cost-effectiveness ratio (ICER) was estimated as the cost per QALY gained. The cost per migraine day avoided was also estimated, as were disaggregated direct and indirect costs. The analysis was conducted from Swedish societal and healthcare system perspectives based on total migraine, chronic migraine and episodic migraine populations, using a discount rate of 3% applied to both costs and health benefits and using year 2019 values. Results: In the base-case deterministic analyses, erenumab treatment resulted in ICERs of Swedish krona (SEK) 34,696 (€3310) and SEK301,565 (€28,769) per QALY gained in the total migraine and episodic migraine populations, respectively. Erenumab was dominant in the chronic migraine population. In the total migraine population, the use of erenumab resulted in a net benefit to society of SEK81,739 (€7773) per patient, assuming a willingness-to-pay threshold of SEK300,000 (€28,528) per QALY. Conclusions: Our analysis suggests that erenumab is a cost-effective treatment for migraine with a willingness-to-pay threshold of SEK300,000 per QALY.

AB - Background: Migraine is a common neurological disease that disproportionately affects females and has a peak incidence during productive years, resulting in significant burden. Objective: The aim of the study was to determine the cost effectiveness of erenumab for the preventive treatment of migraine. Methods: A hybrid decision-tree plus Markov model was developed to evaluate the cost effectiveness of erenumab as a migraine treatment compared with best supportive care only for patients experiencing at least 4 monthly migraine days for whom at least two prior preventive treatments had failed. Clinical efficacy data were based on results from four randomized controlled trials of erenumab against placebo. The primary outcomes were costs, migraine days, and quality-adjusted life-years (QALYs). An incremental cost-effectiveness ratio (ICER) was estimated as the cost per QALY gained. The cost per migraine day avoided was also estimated, as were disaggregated direct and indirect costs. The analysis was conducted from Swedish societal and healthcare system perspectives based on total migraine, chronic migraine and episodic migraine populations, using a discount rate of 3% applied to both costs and health benefits and using year 2019 values. Results: In the base-case deterministic analyses, erenumab treatment resulted in ICERs of Swedish krona (SEK) 34,696 (€3310) and SEK301,565 (€28,769) per QALY gained in the total migraine and episodic migraine populations, respectively. Erenumab was dominant in the chronic migraine population. In the total migraine population, the use of erenumab resulted in a net benefit to society of SEK81,739 (€7773) per patient, assuming a willingness-to-pay threshold of SEK300,000 (€28,528) per QALY. Conclusions: Our analysis suggests that erenumab is a cost-effective treatment for migraine with a willingness-to-pay threshold of SEK300,000 per QALY.

UR - http://www.scopus.com/inward/record.url?scp=85099984941&partnerID=8YFLogxK

U2 - 10.1007/s40273-020-00996-2

DO - 10.1007/s40273-020-00996-2

M3 - Article

AN - SCOPUS:85099984941

SN - 1170-7690

VL - 39

SP - 357

EP - 372

JO - PharmacoEconomics

JF - PharmacoEconomics

IS - 3

ER -