Estimating the clinical effectiveness and value-based price range of erenumab for the prevention of migraine in patients with prior treatment failures: a US societal perspective

Richard B. Lipton, Alan Brennan, Stephen Palmer, Anthony J. Hatswell, Joshua K. Porter, Sandhya Sapra, Guillermo Villa, Neel Shah, Stewart Tepper, David Dodick

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Frequent migraine with four or more headache days per month is a common, disabling neurovascular disease. From a US societal perspective, this analysis models the clinical efficacy and estimates the value-based price (VBP) for erenumab, a fully human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor. Methods: A Markov health state transition model was developed to estimate the incremental costs, quality-adjusted life-years (QALYs), and value-based price range for erenumab in migraine prevention. The model comprises “on preventive treatment”, “off preventive treatment”, and “death” health states across a 10-year time horizon. The evaluation compared erenumab to no preventive treatment in episodic and chronic migraine patients that have failed at least one preventive therapy. Therapeutic benefits are based on estimated changes in monthly migraine days (MMD) from erenumab pivotal clinical trials and a network meta-analysis of migraine studies. Utilities were estimated using previously published mapping algorithms. A VBP analysis was performed to identify maximum erenumab annual prices at willingness-to-pay (WTP) thresholds of $100,000–$200,000 per QALY. Estimates of VBP under different scenarios such as choice of different comparators, assumptions around inclusion of placebo effect, and exclusion of work productivity losses were also generated. Results: Erenumab resulted in incremental QALYs of 0.185 vs supportive care (SC) and estimated cost offsets due to reduced MMD of $8,482 over 10 years, with an average duration of treatment of 2.01 years. The estimated VBP at WTP thresholds of $100,000–$200,000 for erenumab compared to SC ranged from $14,238–$23,998. VBP estimates including the placebo effect and excluding work productivity ranged from $7,445–$13,809; increasing to $12,151–$18,589 with onabotulinumtoxinA as a comparator in chronic migraine. Conclusion: Erenumab is predicted to reduce migraine-related direct and indirect costs, and increase QALYs compared to SC.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalJournal of Medical Economics
DOIs
StateAccepted/In press - Apr 3 2018

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Treatment Failure
Migraine Disorders
Quality-Adjusted Life Years
Placebo Effect
Costs and Cost Analysis
Therapeutics
Health Transition
Calcitonin Gene-Related Peptide Receptors
Headache
Monoclonal Antibodies
Clinical Trials
Health

Keywords

  • CGRP
  • chronic migraine
  • cost-effectiveness analysis
  • economic evaluation
  • episodic migraine
  • erenumab
  • indirect costs
  • productivity
  • Value based-price

ASJC Scopus subject areas

  • Health Policy

Cite this

Estimating the clinical effectiveness and value-based price range of erenumab for the prevention of migraine in patients with prior treatment failures : a US societal perspective. / Lipton, Richard B.; Brennan, Alan; Palmer, Stephen; Hatswell, Anthony J.; Porter, Joshua K.; Sapra, Sandhya; Villa, Guillermo; Shah, Neel; Tepper, Stewart; Dodick, David.

In: Journal of Medical Economics, 03.04.2018, p. 1-10.

Research output: Contribution to journalArticle

Lipton, Richard B. ; Brennan, Alan ; Palmer, Stephen ; Hatswell, Anthony J. ; Porter, Joshua K. ; Sapra, Sandhya ; Villa, Guillermo ; Shah, Neel ; Tepper, Stewart ; Dodick, David. / Estimating the clinical effectiveness and value-based price range of erenumab for the prevention of migraine in patients with prior treatment failures : a US societal perspective. In: Journal of Medical Economics. 2018 ; pp. 1-10.
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AU - Palmer, Stephen

AU - Hatswell, Anthony J.

AU - Porter, Joshua K.

AU - Sapra, Sandhya

AU - Villa, Guillermo

AU - Shah, Neel

AU - Tepper, Stewart

AU - Dodick, David

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N2 - Background: Frequent migraine with four or more headache days per month is a common, disabling neurovascular disease. From a US societal perspective, this analysis models the clinical efficacy and estimates the value-based price (VBP) for erenumab, a fully human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor. Methods: A Markov health state transition model was developed to estimate the incremental costs, quality-adjusted life-years (QALYs), and value-based price range for erenumab in migraine prevention. The model comprises “on preventive treatment”, “off preventive treatment”, and “death” health states across a 10-year time horizon. The evaluation compared erenumab to no preventive treatment in episodic and chronic migraine patients that have failed at least one preventive therapy. Therapeutic benefits are based on estimated changes in monthly migraine days (MMD) from erenumab pivotal clinical trials and a network meta-analysis of migraine studies. Utilities were estimated using previously published mapping algorithms. A VBP analysis was performed to identify maximum erenumab annual prices at willingness-to-pay (WTP) thresholds of $100,000–$200,000 per QALY. Estimates of VBP under different scenarios such as choice of different comparators, assumptions around inclusion of placebo effect, and exclusion of work productivity losses were also generated. Results: Erenumab resulted in incremental QALYs of 0.185 vs supportive care (SC) and estimated cost offsets due to reduced MMD of $8,482 over 10 years, with an average duration of treatment of 2.01 years. The estimated VBP at WTP thresholds of $100,000–$200,000 for erenumab compared to SC ranged from $14,238–$23,998. VBP estimates including the placebo effect and excluding work productivity ranged from $7,445–$13,809; increasing to $12,151–$18,589 with onabotulinumtoxinA as a comparator in chronic migraine. Conclusion: Erenumab is predicted to reduce migraine-related direct and indirect costs, and increase QALYs compared to SC.

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