偏头痛预防中抗 CGRP 单克隆抗体的早期和年度预计节省：工作年龄人群的成本效益分析。

Early and annual projected savings from anti-CGRP monoclonal antibodies in migraine prevention: a cost-benefit analysis in the working-age population.

机构信息

Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.

Headache Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.

出版信息

J Headache Pain. 2024 Feb 12;25(1):21. doi: 10.1186/s10194-024-01727-0.

DOI:10.1186/s10194-024-01727-0

PMID:38347485

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10860274/

Abstract

BACKGROUND

Migraine is one of the main causes of disability worldwide. Anti-CGRP monoclonal antibodies (MAbs) have proven to be safe and efficacious as preventive migraine treatments. However, their use is restricted in many countries due to their apparently high cost. Cost-benefit studies are needed.

OBJECTIVE

To study the cost-benefit of anti-CGRP MAbs in working-age patients with migraine.

METHODS

This is a prospective cohort study of consecutive migraine patients treated with anti-CGRP MAbs (erenumab, fremanezumab and galcanezumab) following National reimbursement policy in a specialized headache clinic. Migraine characteristics and the work impact scale (WPAI) were compared between baseline (M0) and after 3 (M3) and 6 months (M6) of treatment. Using WPAI and the municipal average hourly wage, we calculated indirect costs (absenteeism and presenteeism) at each time point. Direct costs (emergency visits, acute medication use) were also analysed. A cost-benefit study was performed considering the different costs and savings of treating with MAbs. Based on these data an annual projection was conducted.

RESULTS

From 256 treated working-age patients, 148 were employed (89.2% women; mean age 48.0 ± 8.5 years), of which 41.2% (61/148) were responders (> 50% reduction in monthly headache days (MHD)). Statistically significant reductions between M0 and M3/M6 were found in absenteeism (p < 0.001) and presenteeism (p < 0.001). Average savings in indirect costs per patient at M3 were absenteeism 105.4 euros/month and presenteeism 394.3 euros/month, similar for M6. Considering the monthly cost of anti-CGRP MAbs, the cost-benefit analysis showed savings of 159.8 euros per patient at M3, with an annual projected savings of 639.2 euros/patient. Both responders and partial responders (30-50% reduction in MHD) presented a positive cost-benefit balance. The overall savings of the cohort at M3/M6 compensated the negative cost-benefit balance for non-responders (< 30% reduction in MHD).

CONCLUSION

Anti-CGRP MAbs have a positive impact in the workforce significantly reducing absenteeism and presenteeism. In Spain, this benefit overcomes the expenses derived from their use already at 3 months and is potentially sustainable at longer term; also in patients who are only partial responders, prompting reconsideration of current reimbursement criteria and motivating the extension of similar cost-benefit studies in other countries.

摘要

背景

偏头痛是全球主要致残原因之一。抗降钙素基因相关肽（CGRP）单克隆抗体（mAb）已被证明是安全有效的偏头痛预防治疗药物。然而，由于其明显较高的成本，这些药物在许多国家的使用受到限制。需要进行成本效益研究。

目的

研究偏头痛患者在工作年龄使用抗 CGRP mAb 的成本效益。

方法

这是一项前瞻性队列研究，在专门的头痛诊所，根据国家报销政策，对接受抗 CGRP mAb（erenumab、fremanezumab 和 galcanezumab）治疗的偏头痛患者进行连续研究。在基线（M0）、治疗后 3 个月（M3）和 6 个月（M6）时，比较偏头痛特征和工作影响量表（WPAI）。使用 WPAI 和城市平均小时工资，我们计算了每个时间点的间接成本（旷工和出勤损失）。还分析了直接成本（急诊就诊、急性药物使用）。考虑到 mAb 治疗的不同成本和节省，进行了成本效益研究。基于这些数据进行了年度预测。

结果

在 256 名接受治疗的工作年龄患者中，有 148 人就业（89.2%为女性；平均年龄 48.0±8.5 岁），其中 41.2%（61/148）为应答者（每月头痛天数减少>50%（MHD））。在 M0 与 M3/M6 之间，旷工（p<0.001）和出勤损失（p<0.001）均有统计学显著降低。M3 时每位患者的间接成本平均节省为旷工 105.4 欧元/月，出勤损失 394.3 欧元/月，M6 时相似。考虑到抗 CGRP mAb 的每月成本，M3 时的成本效益分析显示每位患者节省 159.8 欧元，每年预计每位患者节省 639.2 欧元。应答者和部分应答者（MHD 减少 30-50%）均呈现出积极的成本效益平衡。M3/M6 时队列的总体节省弥补了非应答者（MHD 减少<30%）的负成本效益平衡。