Department of Health Policy and Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, USA.
Population Informatics Lab, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, USA.
Clin Drug Investig. 2019 Oct;39(10):979-990. doi: 10.1007/s40261-019-00827-z.
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.
偏头痛是一种常见的慢性神经血管性脑疾病，其多方面的经济成本不可忽视。现有的预防治疗方法包括选择性使用肉毒杆菌毒素 A，旨在减少对初始口服药物预防治疗失败的患者的偏头痛发病率。依瑞奈尤单抗是一种新的偏头痛预防治疗药物。
评估依瑞奈尤单抗与肉毒杆菌毒素 A 预防治疗慢性偏头痛（CM）患者的成本和结局差异，以评估该治疗方法的经济价值。
我们从支付者和社会角度使用决策树分析模型进行成本效益分析。结果以避免的偏头痛发作和质量调整生命年（QALYs）表示。我们从现有文献中获得模型输入。决策路径调整了两种治疗方法的依从性概率变化和由此产生的差异效果。直接成本包括两种药物的成本和管理成本、常规护理下使用的急性药物成本以及住院、医生和急诊就诊的成本。社会视角分析的间接成本包括工作日损失的工资。分析的时间范围为 1 年，所有成本均按 2019 年欧元（€）计算。进行敏感性分析以控制参数不确定性并评估研究结果的稳健性。
我们的结果表明，与肉毒杆菌毒素 A 相比，依瑞奈尤单抗治疗 CM 的增量成本效益比（ICER）分别为从社会和支付者角度获得每 QALY 的€218,870 和€231,554，以及每避免一次偏头痛的€620 和€656。使用等于当地人均国内生产总值（GDP）三倍的常见成本效益阈值（€49,000），依瑞奈尤单抗的 ICER 要低于这一阈值，依瑞奈尤单抗的价格必须不超过€192（社会视角）或€173（支付者视角）。
在希腊，与现有的肉毒杆菌毒素 A 替代疗法相比，依瑞奈尤单抗预防性治疗 CM 可能具有成本效益，从支付者和社会角度来看，但前提是价格大幅折扣。尽管如此，依瑞奈尤单抗仍可被视为对肉毒杆菌毒素 A 治疗失败的患者的一种治疗选择。
