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Abstract Details

10-Year Cost-effectiveness Analyses of Fremanezumab Compared to Erenumab as Preventive Treatment in Episodic Migraine for Patients With Inadequate Response to Prior Preventive Treatments
Headache
P6 - Poster Session 6 (12:00 PM-1:00 PM)
7-001
Fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene-related peptide, is approved for the preventive treatment of episodic migraine in adults.
Cost-effectiveness of fremanezumab versus erenumab for the prevention of episodic migraine (EM) in patients who had responded inadequately to 2 to 4 prior preventive treatments was examined.
A semi-Markov cost-effectiveness model (CEM) was developed with a 4-week cycle and 10-year analysis time horizon. Costs and benefits were discounted at 3.0% annual rates. Treatment efficacies were incorporated as reductions in mean migraine days (MDs)/28 days versus placebo. Patient cohorts were distributed among MD categories (0–28 MDs/28 days) based on mean MD levels. For this study, EM was defined as patients with 4 to 14 MDs per 28 days at the start of the study. The CEM estimated costs (fremanezumab and erenumab acquisition costs, MD-related costs [direct and indirect]) and health-related-quality-of-life (MD- and treatment status–based utilities) for fremanezumab and erenumab. Outcome measures were costs, reduction in MDs, and quality-adjusted life-years (QALYs). Only background mortality was modeled. Analyses were performed on an EM population with 2-4 prior treatment failures. The incremental cost-effectiveness ratios (ICERs) were reported as cost/QALY gained between fremanezumab and erenumab. Fremanezumab and erenumab (140mg dosing) MDs/28-day reductions versus placebo were sourced from a Network Meta-Analysis (NMA). The analysis assumed the same discontinuation rate for fremanezumab and erenumab.
In the base-case 10-year analysis time horizon, fremanezumab dominates erenumab (less costly, more effective), with an average incremental cost savings of $1,795/patient, incremental QALYs of 0.037/patient, and a reduction in MDs of 33.3 MDs/patient. Excluding indirect costs, fremanezumab still dominates erenumab, with an average incremental cost savings of $936.96/patient.
Based on current pricing and randomized controlled trial results, fremanezumab treatment is cost effective versus erenumab.
Authors/Disclosures
Lee Smolen
PRESENTER
Lee Smolen has received personal compensation for serving as an employee of Medical Decision Modeling Inc..
Joshua M. Cohen, MD No disclosure on file
Timothy M. Klein Timothy M. Klein has received personal compensation for serving as an employee of Medical Decision Modeling Inc..
Sanjay Gandhi, MD (Teva Pharmaceuticals) Dr. Gandhi has received personal compensation for serving as an employee of Teva Pharmaceuticals.
Stephen F. Thompson Stephen Thompson has received personal compensation for serving as an employee of Teva Pharmaceuticals.