Cost-Effectiveness of Erenumab for the Preventive Treatment of Episodic and Chronic Migraine

By Deena Kuruvilla, MD

With the release of erenumab, the entire treatment landscape for migraine has transformed. Erenumab is a monthly injectable medication that targets the calcitonin gene-related peptide receptor for the prevention of migraine. It has been FDA approved for the prevention of episodic migraine (EM) (0-14 headache days monthly) and chronic migraine (CM) (15 or more headache days monthly). It is the first preventive medication that is specifically developed for migraine. Due to the fact that it is the first in its class, there has been major buzz about its release. It has been featured in The New York Times and U.S. News & World Report among many other news outlets. While the existing data looks promising, there have been many question marks about insurance coverage and cost of the drug for patients. While the drug’s manufacturer provides a free trial period for the first two months of treatment, providers have difficulties getting the drug covered under insurance, especially if the patient is also receiving Botox therapy.

In this month’s edition of Cephalalgia, Sussman and colleagues aimed to assess the cost-effectiveness of erenumab 140 mg for the prophylactic treatment of EM and CM. CM is certainly associated with higher economic burden and disability. Patients with CM have higher direct and indirect health care costs due to a loss of work productivity and disability. In a 2006 AMPP follow-up study by Munakata et al, individuals with CM reported 21 hours per month lost to reduced productivity, and seven hours per month lost to absenteeism.

The objective of Sussman’s study is to understand the cost-effectiveness of erenumab 140 mg compared with no preventive treatment (NPT) in EM and compared with NPT or Botox in CM. Patients included failed one preventive therapy because erenumab is expected to be used as a second line treatment due to its cost. Patients were included via a simulated study design (The Monte Carlo method). They were assigned to a post-treatment monthly migraine days (MMD) category based on their baseline MMD and treatment effect. They were followed over two years. The primary outcome included the incremental cost effectiveness ratio (ICER) presented as cost per quality-adjusted life year gained (QALY).


AUTHOR AFFILIATIONS: Matthew Sussman, Jennifer Benner and Joseph Menzin are affiliated with Boston Health Economics, Inc., in Waltham, MA. Peter Neumann is affiliated with the Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston.

FUNDING: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was sponsored by Amgen Inc. Matthew Sussman, Jennifer Benner, and Joseph Menzin are employees of and Peter Neumann is a consultant to Boston Health Economics, Inc. and were paid consultants to Amgen Inc. in connection with the study and development of this research article.

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