Longitudinal Assessment Reveals Cost-Effectiveness of Erenumab for Treatment of Migraine

A longitudinal assessment of the cost-effectiveness of erenumab as a treatment for migraine exhibited higher patient utility when compared with placebo, according to study findings published this week in the journal Health and Quality of Life Outcomes.

Migraines are typically initiated by the calcitonin gene-related peptide (CGRP) or its receptor, which has led to the development of treatments that act on these catalysts. Previous studies on the migraine medication erenumab, a fully human monoclonal antibody directed against the CGRP receptor, has shown its efficacy in higher doses as well as its long-term safety in treating patients with migraine.

The cost-effectiveness of erenumab, which is determined through measuring patients’ utility values in relation with their monthly migraine days (MMD), is a vital measurement that researchers sought to examine by determining whether its ability to treat migraines warranted its price. Data was derived from disease-specific patient-reported outcomes from 3 erenumab clinical studies (2 in episodic migraine and 1 in chronic migraine) and was then mapped to the 5-dimension EuroQol questionnaire as a function of the Migraine-Specific Quality of Life Questionnaire (MSQ) and the Headache Impact Test (HIT-6) using published algorithms.

Researchers analyzed the cost-effectiveness of erenumab utilizing 4 different modelling approaches to assess utility values as a function of MMDs:

• A linear mixed effects model with restricted maximum likelihood (REML), a fractional response model with logit link, a fractional response model with probit link, and a beta regression model
• mapped utility values were used to estimate generic, preference-based utility values suitable for use in economic models

Study results exhibited similar root mean squared errors among the linear mixed effects model with REML (0.115), fractional response model with logit link (0.114), fractional response model with probit link (0.114), and beta regression model (0.114) when mapped with MSQ. Additionally, mean absolute errors for the 4 models were similar as well when mapped from MSQ (0.085, 0.086, 0.085 and 0.085) and HIT-6 (0.087, 0.088, 0.088 and 0.089).

Study authors concluded that the assessment of longitudinal approaches proved its efficacy in modelling utility values through the 4 models proposed. “Linking patient utility values to MMDs allows utility estimates for different levels of MMD to be predicted, for use in economic evaluations of preventive therapies,” said the authors. The study suggests erenumab’s potential as a cost-effective therapy.

“Mapped utility values for patients treated with erenumab were generally higher than those for individuals treated with placebo with equivalent number of MMDs,” said the authors.

Reference

Di Tanna GL, Porter JK, Lipton RB, et al. Longitudinal assessment of utilities in patients with migraine: an analysis of erenumab randomized controlled trials. Health Qual Life Outcomes. 2019 Nov 12;17(1):171.