Erenumab as a first line preventive treatment for episodic migraine in Spain: a cost-effectiveness analysis.

Abstract text (incl. figure legends and references)

OBJECTIVE: To perform a cost-effectiveness analysis of erenumab 140 mg vs topiramate for the prophylaxis of episodic migraine in preventive treatment naïve patients in Spain.

METHODS: We built a cost-effectiveness analysis using a Markov model with 12-week cycles based on responders from the societal perspective. A responder was defined as having a minimum 50% reduction in the number of monthly migraine days (MMDs). The hypothetical cohort were patients with episodic migraine (4+ MMD), preventive treatment naive (80.5% women and mean age of 41 years). We estimated quality-adjusted life years (QALY) and MMD over a 5-year time horizon. Incremental cost-effectiveness ratios based on QALYs and MMD avoided were performed. Resource use and costs (2022) were obtained from official data sources and were validated by an expert panel. Sensitivity analysis was performed to validate the robustness.

RESULTS:

At 5 years, QALYs were 3.23 for topiramate and 3.35 for erenumab. Erenumab showed an incremental cost per patient of 2.986€ vs topiramate. Incremental cost per QALY gained with erenumab was 24.859€, below the Spanish efficiency threshold. Patients treated with erenumab improved mean MMDs over time, from 9.05 MMDs at baseline to 6.03 MMDs at 5 years, while topiramate patients improved to 7.71. Given the total reduction of migraine days with erenumab, [MMD1] the cost per MMDs avoided with erenumab was 33€.

CONCLUSION: Erenumab (Aimovig®) is a cost-effective alternative vs topiramate for episodic migraine from the societal perspective. Our findings suggest that erenumab (Aimovig®) is cost-effective in preventive treatment naïve patients.