Cost-Effectiveness Analysis of Erenumab Versus OnabotulinumtoxinA for Patients with Chronic Migraine Attacks in Greece
Migraine is a common, chronic neurovascular brain disorder with non-negligible multifaceted economic costs. Existing preventive treatments involve the selective use of onabotulinumtoxinA, which aims at migraine morbidity reduction for patients who have failed initial preventive treatment with oral agents. Erenumab is a new preventive treatment for migraines.
To evaluate the differences in costs and outcomes of the preventive treatment with erenumab versus onabotulinumtoxinA in patients with chronic migraines (CM) in Greece to assess the economic value of this treatment.
We conducted a cost-effectiveness analysis from both the payer and the societal perspective using a decision-tree analytic model. Outcomes were expressed in migraines avoided and in quality-adjusted life-years (QALYs). We obtained model inputs from the existing literature. The decision path adjusted for variation in the probability of adherence and the resulting differential effectiveness between the two treatments. Direct costs included the cost of the two drugs and administration costs, the costs of acute drugs used under usual care, and the costs of hospitalization, physician, and emergency department visits. Indirect costs for the societal perspective analyses included wages lost on workdays. The time-horizon of the analysis was 1 year and all costs were calculated in 2019 euros (€). Sensitivity analyses were conducted to control for parameter uncertainty and to evaluate the robustness of the findings.
Our results indicate that treatment of CM with erenumab compared to onabotulinumtoxinA resulted in incremental cost-effectiveness ratios (ICERs) of €218,870 and €231,554 per QALY gained and €620 and €656 per migraine avoided, from the societal and the payer’s perspective, respectively. Using a common cost-effectiveness threshold equal to three times the local gross domestic product (GDP) per capita (€49,000), for the erenumab ICERs to fall below this threshold, the erenumab price would have to be no more than €192 (societal perspective) or €173 (payer perspective).
The prophylactic treatment of CM with erenumab in Greece might be cost effective compared to the existing alternative of onabotulinumtoxinA from both the payer and the societal perspective, but only at a highly discounted price. Nevertheless, erenumab could be considered a therapeutic option for patients who fail treatment with onabotulinumtoxinA.
The authors would like to acknowledge Mr. Aristeidis Draganigos for his valuable input into the methodological part of this study.
All authors contributed to the coordination of the study and drafting of the manuscript. TVG conceived and designed the study. TVG led the model development and performed the analyses. RLO and DDM contributed to the design and development of the model. DDM provided overall direction to the study. RLO, AV, and PK critically reviewed the analyses and assisted with the interpretation of the results. All authors reviewed and approved the final version of the manuscript for publication.
Compliance with Ethical Standards
This study used data from existing published sources in a computational model. The research did not entail the use of data for any human subject at an individual level; thus institutional review board approval and informed consent were deemed unnecessary.
The authors did not receive any funding for this study.
Conflict of interest
The authors declare that they have no conflicts of interest. Other disclosures: DDM received honoraria for lecturing, consulting fees or research grants form Sanofi-Genzyme, Amgen, Allergan, Cefaly, Electrocore, Eli Lilly, Novartis, Merz, Merck-Serono, Roche, and Teva and has participated in clinical trials for agents analyzed in this study, which were however unrelated to this analysis.
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