From the Department of Plastic and Reconstructive Surgery, The Ohio State University; and the Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital.
Plast Reconstr Surg. 2020 Feb;145(2):401e-406e. doi: 10.1097/PRS.0000000000006480.
Chronic migraines affect approximately 2 percent of the U.S. population and cost an estimated $17 billion per year. OnabotulinumtoxinA (botulinum toxin type A) is a U.S. Food and Drug Administration-approved prophylactic medication for chronic migraine headaches and is best injected in a targeted fashion into specific trigger sites. The purpose of this study was to determine the cost-effectiveness of long-term, targeted botulinum toxin type A versus peripheral trigger site deactivation surgery for the treatment of migraine headaches.
A Markov model was constructed to examine long-term, targeted botulinum toxin type A versus peripheral trigger site deactivation surgery. Costs, utilities, and other model inputs were identified from the literature. One-way and probabilistic sensitivity analyses were performed. An incremental cost-effectiveness ratio under $50,000 per quality-adjusted life-year was considered cost-effective.
The mean cost of peripheral trigger site deactivation surgery was $10,303, with an effectiveness of 7.06; whereas the mean cost of long-term, targeted botulinum toxin type A was $36,071, with an effectiveness of 6.34. Trigger-site deactivation surgery is more effective and less costly over the time horizon of the model. One-way sensitivity analysis revealed that surgery is the most cost-effective treatment in patients requiring treatment for greater than 6.75 years.
Based on this model, peripheral trigger site deactivation surgery is the more cost-effective option for treating refractory migraine headaches requiring treatment beyond 6.75 years. The model reveals that peripheral trigger-site deactivation surgery is more effective and less costly than long-term, targeted botulinum toxin type A over the course of a patient's lifetime.
慢性偏头痛影响了美国约 2%的人口，每年造成的损失估计达 170 亿美元。肉毒杆菌毒素 A（A型肉毒毒素）是美国食品和药物管理局批准的一种预防慢性偏头痛的药物，最好针对特定触发点以靶向方式注射。本研究旨在确定长期、靶向肉毒毒素 A 与外周触发点失活手术治疗偏头痛的成本效益。
构建了一个马尔可夫模型，以研究长期、靶向肉毒毒素 A 与外周触发点失活手术。从文献中确定了成本、效用和其他模型输入。进行了单因素敏感性分析和概率敏感性分析。增量成本效益比低于每质量调整生命年 50000 美元被认为具有成本效益。
外周触发点失活手术的平均成本为 10303 美元，效果为 7.06；而长期、靶向肉毒毒素 A 的平均成本为 36071 美元，效果为 6.34。在模型的时间范围内，失活手术更有效且成本更低。单因素敏感性分析显示，对于需要治疗超过 6.75 年的患者，手术是最具成本效益的治疗方法。
基于该模型，对于需要治疗超过 6.75 年的难治性偏头痛，外周触发点失活手术是更具成本效益的选择。该模型表明，在外周触发点失活手术在患者的整个生命周期内比长期、靶向肉毒毒素 A 更有效且成本更低。
