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. 2024 Apr 18;25(1):59.
doi: 10.1186/s10194-024-01749-8.

An economic evaluation of eptinezumab for the preventive treatment of migraine in the UK, with consideration for natural history and work productivity

Edward Griffin  1 , Gawain Shirley  2 , Xin Ying Lee  3 , Susanne F Awad  4 , Alok Tyagi  5 , Peter J Goadsby  6
Affiliations

An economic evaluation of eptinezumab for the preventive treatment of migraine in the UK, with consideration for natural history and work productivity

Edward Griffin et al. J Headache Pain. .

Abstract

Background: Migraine is a highly prevalent neurological disease with a substantial societal burden due to lost productivity. From a societal perspective, we assessed the cost-effectiveness of eptinezumab for the preventive treatment of migraine.

Methods: An individual patient simulation of discrete competing events was developed to evaluate eptinezumab cost-effectiveness compared to best supportive care for adults in the United Kingdom with ≥ 4 migraine days per month and prior failure of ≥ 3 preventive migraine treatments. Individuals with sampled baseline characteristics were created to represent this population, which comprised dedicated episodic and chronic migraine subpopulations. Clinical efficacy, utility, and work productivity inputs were based on results from the DELIVER randomised controlled trial (NCT04418765). Timing of natural history events and treatment holidays-informed by the literature-were simulated to unmask any natural improvement of the disease unrelated to treatment. The primary outcomes were monthly migraine days, migraine-associated costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio, and net monetary benefit, each evaluated over a 5-year time horizon from 2020. Secondary analyses explored a lifetime horizon and an alternative treatment stopping rule.

Results: Treatment with eptinezumab resulted in an average of 0.231 QALYs gained at a saving of £4,894 over 5 years, making eptinezumab dominant over best supportive care (i.e., better health outcomes and less costly). This result was confirmed by the probabilistic analysis and all alternative assumption scenarios under the same societal perspective. Univariate testing of inputs showed net monetary benefit was most sensitive to the number of days of productivity loss, and monthly salary.

Conclusions: This economic evaluation shows that from a societal perspective, eptinezumab is a cost-effective treatment in patients with ≥ 4 migraine days per month and for whom ≥ 3 other preventive migraine treatments have failed.

Trial registration: N/A.

Keywords: Anti-CGRP mAbs; Cost-effectiveness; Eptinezumab; Healthcare costs; Migraine; Natural history; Productivity; UK.

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Conflict of interest statement

Edward Griffin is an independent health economist contracted to H. Lundbeck A/S or one of its affiliates through Edward Griffin Consulting Ltd (UK).

Gawain Shirley, Xin Ying Lee, and Susanne F. Awad are employees of H. Lundbeck A/S or one of its subsidiary companies.

Alok Tyagi reports, over the last 36 months, participation on a Data Safety Monitoring Board or Advisory Board for Lundbeck.

Peter J. Goadsby reports, over the last 36 months, grants from Celgene and Kallyope, and personal fees from Aeon Biopharma, AbbVie, Amgen, eNeura, CoolTech LLC, Dr Reddys, Eli-Lilly and Company, Epalex, Linpharma, Lundbeck, Man&Science, Novartis, Pfizer, Sanofi, Satsuma, Shiratronics, and Teva Pharmaceuticals, and personal fees for advice through Gerson Lehrman Group, Guidepoint, SAI Med Partners, Vector Metric, and fees for educational materials from CME Outfitters, and publishing royalties or fees from Massachusetts Medical Society, Oxford University Press, UptoDate and Wolters Kluwer, and a patent magnetic stimulation for headache (No. WO2016090333 A1) assigned to eNeura without fee.

Figures

Fig. 1
Fig. 1
Model structure depicted as clinical states and permitted paths with (A) best supportive care (BSC) and (B) eptinezumab. Key: Ovals are clinical states. Arrows represent a permitted movement to or from a clinical state. Dashed ovals are clinical states with entry allowed from any other clinical state. * 3-month treatment holiday for assessment of natural improvement (maximum of five, 12 months between). ◊ Clinical state where natural improvement is permitted after five treatment holiday cycles (see methods for details of how natural history was applied)
Fig. 2
Fig. 2
Modelled modes of discontinuation of eptinezumab
Fig. 3
Fig. 3
Self-reported migraine-related impairment of work productivity in the full DELIVER population (2–4 prior treatment failures) over 24 weeks, by administered treatment
Fig. 4
Fig. 4
A tornado plot of key parameters and their impact on net monetary benefit (at £20,000 per QALY) when varied. Abbreviations: BSC, best supportive care; EM, episodic migraine; CM, chronic migraine; UK, United Kingdom
Fig. 5
Fig. 5
Probabilistic outcomes on the cost-effectiveness plane, 5-year time horizon. Note on figure: Only the Northeast and Southeast quadrants of the cost-effectiveness plane are presented since no probabilistic sensitivity analysis iterations produced negative incremental QALYs. Abbreviations: Det, Deterministic; QALY, Quality-adjusted life-year; WTP, willingness-to-pay
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