A systematic review was conducted on placebo-controlled trials of preventive drugs for chronic migraine in terms of cost-effectiveness. The cost-effectiveness of several currently prescribable drugs including Onabotulinum toxin A, Eptinezumab, Fremanezumab, Galcanezumab, and Topiramate, each compared to placebo, was assessed. A Markov model was developed to estimate the costs and quality-adjusted life years (QALYs) for these medications from a UK NHS and Personal Social Services perspective.
Migraine, the world’s second most common disabling disorder, affects 15% of UK adults and costs the UK over £1.5 billion per year. Numerous new and expensive drugs have been approved by the National Institute for Health and Care Excellence.
The model used a two-year time horizon with a starting age of 30 years for the patient cohort. Transition probabilities were estimated based on monthly headache days using a network meta-analysis and from published literature. Costs were obtained from published sources and discount rates of 3.5% were applied to both costs and outcomes.
Topiramate Emerges as the Most Favorable Option in Terms of Cost-Effectiveness
Results suggest that Topiramate was the least costly option and generated slightly more QALYs than the placebo, while Eptinezumab 300mg was the most costly option and generated the most QALYs. After excluding dominated options, the incremental cost-effectiveness ratio (ICER) between BTA and Topiramate was £68,000 per QALY gained and the ICER between Eptinezumab 300mg and BTA was not within plausible cost-effectiveness thresholds. The cost-effectiveness acceptability frontier showed that Topiramate is the most cost-effective medication for any amount the decision maker is willing to pay per QALY.
Conclusively, among the various prophylactic medications for managing chronic migraine, only Topiramate was within typical cost-effectiveness threshold ranges. It is suggested that further research is required, ideally an economic evaluation alongside a randomized trial, to compare these newer, expensive CGRP MAbs with the cheaper oral medications.
Original Article DOI: 10.1186/s10194-023-01686-y
Original title: Competing treatments for migraine: a headache for decision-makers
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