Sistema de Salut de Catalunya
Institut Català de la Salut
[Pozo Rosich P] Unitat de Cefalees, Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca de Cefalea i Dolor Neurològic, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. [Poveda JL] Pharmacy Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain. [Crespo C] Axentiva Solutions, Barcelona, Spain. G.M. Statistics Department, Universidad de Barcelona, Barcelona, Spain. [Martínez M, Rodríguez JM] Novartis, Barcelona, Spain. [Irimia P] Department of Neurology, Headache Unit, Clínica Universidad de Navarra, Pamplona, Spain
Vall d'Hebron Barcelona Hospital Campus
2024-03-22T11:48:47Z
2024-03-22T11:48:47Z
2024-03-15
Chronic migraine; Cost-effectiveness; Spain
Migraña crónica; Coste-efectividad; España
Migranya crònica; Cost-efectivitat; Espanya
Background The reimbursement of erenumab in Spain and other European countries is currently restricted because of the cost of this novel therapy to patients with migraine who have experienced previous failures to traditional preventive treatments. However, this reimbursement policy should be preferably based on cost-effectiveness studies, among other criteria. This study performed a cost-effectiveness analysis of erenumab versus topiramate for the prophylactic treatment of episodic migraine (EM) and versus placebo for chronic migraine (CM). Methods A Markov model with a 10-year time horizon, from the perspective of the Spanish National Healthcare System, was constructed based on data from responder and non-responder patients. A responder was defined as having a minimum 50% reduction in the number of monthly migraine days (MMD). A hypothetical cohort of patients with EM with one or more prior preventive treatment failures and patients with CM with more than two treatment failures was considered. The effectiveness score was measured as an incremental cost per quality-adjusted life year (QALY) gained and cost per migraine day (MD) avoided. Data from clinical outcomes and patient characteristics were obtained from erenumab clinical trials (NCT02066415, STRIVE, ARISE, LIBERTY and HER-MES). Deterministic and probabilistic sensitivity analyses were performed to validate the robustness of the model. Results After a 10-year follow-up, the estimated QALYs were 5.88 and 6.11 for patients with EM treated with topiramate and erenumab, respectively. Erenumab showed an incremental cost per patient of €4,420 vs topiramate. For CM patients, erenumab resulted in 0.756 QALYs gained vs placebo; and an incremental cost of €1,814. Patients treated with erenumab achieved reductions in MD for both EM and CM (172 and 568 MDs, respectively). The incremental cost per QALY gained with erenumab was below the Spanish threshold of €30,000/QALY for both health and societal perspectives (EM €19,122/QALY and CM €2,398/QALY). Conclusions Erenumab is cost-effective versus topiramate as a preventive treatment for EM and versus placebo for patients with CM from the perspective of the Spanish National Health System.
This study was funded by Novartis.
Article
Published version
English
Anticossos monoclonals - Ús terapèutic; Migranya - Prevenció; Cost-eficàcia; DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Headache Disorders::Headache Disorders, Primary::Migraine Disorders; PUBLIC HEALTH::Health Policy, Planning and Management::Health Economics::Costs and Cost Analysis::Cost-Benefit Analysis; CHEMICALS AND DRUGS::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Antibodies, Monoclonal::Antibodies, Monoclonal, Humanized; ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos con cefaleas::cefaleas primarias::trastornos migrañosos; SALUD PÚBLICA::Políticas, Planificación y Administración en salud::economía de la salud::costes y análisis de costes::análisis coste-beneficio; COMPUESTOS QUÍMICOS Y DROGAS::aminoácidos, péptidos y proteínas::proteínas::proteínas sanguíneas::inmunoproteínas::inmunoglobulinas::anticuerpos::anticuerpos monoclonales::anticuerpos monoclonales humanizados
BMC
The Journal of Headache and Pain;25(1)
https://doi.org/10.1186/s10194-024-01747-w
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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