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Cost-Effectiveness of Erenumab for the Preventive Treatment of Migraine in Patients with Prior Treatment Failures in Sweden

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Abstract

Background

Migraine is a common neurological disease that disproportionately affects females and has a peak incidence during productive years, resulting in significant burden.

Objective

The aim of the study was to determine the cost effectiveness of erenumab for the preventive treatment of migraine.

Methods

A hybrid decision-tree plus Markov model was developed to evaluate the cost effectiveness of erenumab as a migraine treatment compared with best supportive care only for patients experiencing at least 4 monthly migraine days for whom at least two prior preventive treatments had failed. Clinical efficacy data were based on results from four randomized controlled trials of erenumab against placebo. The primary outcomes were costs, migraine days, and quality-adjusted life-years (QALYs). An incremental cost-effectiveness ratio (ICER) was estimated as the cost per QALY gained. The cost per migraine day avoided was also estimated, as were disaggregated direct and indirect costs. The analysis was conducted from Swedish societal and healthcare system perspectives based on total migraine, chronic migraine and episodic migraine populations, using a discount rate of 3% applied to both costs and health benefits and using year 2019 values.

Results

In the base-case deterministic analyses, erenumab treatment resulted in ICERs of Swedish krona (SEK) 34,696 (€3310) and SEK301,565 (€28,769) per QALY gained in the total migraine and episodic migraine populations, respectively. Erenumab was dominant in the chronic migraine population. In the total migraine population, the use of erenumab resulted in a net benefit to society of SEK81,739 (€7773) per patient, assuming a willingness-to-pay threshold of SEK300,000 (€28,528) per QALY.

Conclusions

Our analysis suggests that erenumab is a cost-effective treatment for migraine with a willingness-to-pay threshold of SEK300,000 per QALY.

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Author information

Authors and Affiliations

  1. Value and Access, Novartis Ireland Limited, Dublin, Ireland

    Ronan Mahon, Philip Cooney & Andriy Danyliv

  2. Market Access, Novartis Sverige AB, Kista, Sweden

    Andrea Lang

  3. Global Patient Access, Novartis Pharma AG, Basel, Switzerland

    Pamela Vo

  4. WW Market Access and HEOR, Novartis Pharma AG, Basel, Switzerland

    Jasper Huels

  5. Value and Access, Novartis Healthcare Private Limited, Hyderabad, India

    Umakanth Vudumula & Sreelatha Vadapalle

  6. Basildon and Thurrock University Hospitals and Queen Mary University, London, UK

    Farooq Maniyar

  7. NIHR-Wellcome Trust King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College London, London, UK

    Peter J. Goadsby

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  1. Ronan Mahon
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Corresponding author

Correspondence to Ronan Mahon.

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Funding

This study was sponsored by Novartis Pharma AG.

Conflicts of Interest

Ronan Mahon, Andrea Lang, Jasper Huels, Philip Cooney, Andriy Danyliv, Umakanth Vudumula, Sreelatha Vadapalle and Pamela Vo are employees of Novartis. Peter J. Goadsby has received personal fees from Alder Biopharmaceuticals, Allergan, Autonomic Technologies Inc., Biohaven Pharmaceuticals Inc., Clexio, Electrocore LLC, eNeura Inc, Impel Neuropharma, MundiPharma, Novartis, Teva Pharmaceuticals and WL Gore; grants and personal fees from Amgen and Eli Lilly and Company; a grant from Celgene; and other funding from Trigemina, all outside the submitted work; has a patent magnetic stimulation for headache licensed to eNeura without fee; and has received fees for publishing from Oxford University Press, Massachusetts Medical Society, Wolters Kluwer and fees for medico-legal work. Farooq Maniyar has received personal fees from Novartis for attending advisory board meetings, key opinion leader meetings and delivering lectures.

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The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors’ contributions

All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for this version to be published.

Acknowledgements

The authors gratefully acknowledge David Campbell of Xcenda for his editorial contributions to this work.

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Mahon, R., Lang, A., Vo, P. et al. Cost-Effectiveness of Erenumab for the Preventive Treatment of Migraine in Patients with Prior Treatment Failures in Sweden. PharmacoEconomics 39, 357–372 (2021). https://doi.org/10.1007/s40273-020-00996-2

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