The cost-effectiveness of onabotulinumtoxinA for the prophylaxis of headache in adults with chronic migraine in the UK

Anthony J. Batty, Ryan N. Hansen, Lisa M. Bloudek, Sepideh F. Varon, Esther J. Hayward, Becky W. Pennington, Richard B. Lipton, Sean D. Sullivan

Research output: Contribution to journalArticle

Abstract

Background: Although chronic migraine is associated with substantial disability and costs, few treatments have been shown to be effective. OnabotulinumtoxinA (Botox, Allergan Inc., Irvine, CA) is the first treatment to be licensed in the UK for the prophylaxis of headaches in adults with chronic migraine. This study aims to evaluate the cost-effectiveness of onabotulinumtoxinA in this indication in the UK. Methods: A state-transition (Markov) model was developed comparing onabotulinumtoxinA to placebo. Efficacy data and utility values were taken from the pooled Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical trials program (n = 1384). Estimates of resource utilisation were taken from the International Burden of Migraine Study (IBMS), and stopping rules were informed by published medical guidelines and clinical data. This study estimated 2-year discounted costs and quality-adjusted life years (QALYs) from the UK National Health Service perspective. Results: At 2 years, treatment with onabotulinumtoxinA was associated with an increase in costs of £1367 and an increase in QALYs of 0.1 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of £15,028. Treatment with onabotulinumtoxinA reduced headache days by an estimated 38 days per year at a cost of £18 per headache day avoided. Sensitivity analysis showed that utility values had the greatest influence on model results. The ICER remained cost-effective at a willingness to pay threshold of £20,000-£30,000/QALY in the majority of scenario analyses as well as in probabilistic sensitivity analysis, where onabotulinumtoxinA was cost-effective on 96% of occasions at a threshold of £20,000/QALY and 98% of occasions at £30,000/QALY. Conclusion: OnabotulinumtoxinA has been shown to reduce the frequency of headaches in patients with chronic migraine and can be considered a cost-effective use of resources in the UK National Health Service. The uncertainties in the model relate to the extrapolation of clinical data beyond the 56-week trial.

Original languageEnglish (US)
Pages (from-to)877-887
Number of pages11
JournalJournal of Medical Economics
Volume16
Issue number7
DOIs
StatePublished - Jul 2013

Fingerprint

Migraine Disorders
Cost-Benefit Analysis
Headache
Quality-Adjusted Life Years
Costs and Cost Analysis
National Health Programs
Placebos
onabotulinumtoxinA
Therapeutics
Health Care Costs
Uncertainty
Clinical Trials
Guidelines
Research

Keywords

  • Chronic migraine
  • Cost effectiveness
  • OnabotulinumtoxinA
  • PREEMPT

ASJC Scopus subject areas

  • Health Policy

Cite this

Batty, A. J., Hansen, R. N., Bloudek, L. M., Varon, S. F., Hayward, E. J., Pennington, B. W., ... Sullivan, S. D. (2013). The cost-effectiveness of onabotulinumtoxinA for the prophylaxis of headache in adults with chronic migraine in the UK. Journal of Medical Economics, 16(7), 877-887. https://doi.org/10.3111/13696998.2013.802694

The cost-effectiveness of onabotulinumtoxinA for the prophylaxis of headache in adults with chronic migraine in the UK. / Batty, Anthony J.; Hansen, Ryan N.; Bloudek, Lisa M.; Varon, Sepideh F.; Hayward, Esther J.; Pennington, Becky W.; Lipton, Richard B.; Sullivan, Sean D.

In: Journal of Medical Economics, Vol. 16, No. 7, 07.2013, p. 877-887.

Research output: Contribution to journalArticle

Batty, Anthony J. ; Hansen, Ryan N. ; Bloudek, Lisa M. ; Varon, Sepideh F. ; Hayward, Esther J. ; Pennington, Becky W. ; Lipton, Richard B. ; Sullivan, Sean D. / The cost-effectiveness of onabotulinumtoxinA for the prophylaxis of headache in adults with chronic migraine in the UK. In: Journal of Medical Economics. 2013 ; Vol. 16, No. 7. pp. 877-887.
@article{c7175129db6447af8ae193bcc42030cb,
title = "The cost-effectiveness of onabotulinumtoxinA for the prophylaxis of headache in adults with chronic migraine in the UK",
abstract = "Background: Although chronic migraine is associated with substantial disability and costs, few treatments have been shown to be effective. OnabotulinumtoxinA (Botox, Allergan Inc., Irvine, CA) is the first treatment to be licensed in the UK for the prophylaxis of headaches in adults with chronic migraine. This study aims to evaluate the cost-effectiveness of onabotulinumtoxinA in this indication in the UK. Methods: A state-transition (Markov) model was developed comparing onabotulinumtoxinA to placebo. Efficacy data and utility values were taken from the pooled Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical trials program (n = 1384). Estimates of resource utilisation were taken from the International Burden of Migraine Study (IBMS), and stopping rules were informed by published medical guidelines and clinical data. This study estimated 2-year discounted costs and quality-adjusted life years (QALYs) from the UK National Health Service perspective. Results: At 2 years, treatment with onabotulinumtoxinA was associated with an increase in costs of £1367 and an increase in QALYs of 0.1 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of £15,028. Treatment with onabotulinumtoxinA reduced headache days by an estimated 38 days per year at a cost of £18 per headache day avoided. Sensitivity analysis showed that utility values had the greatest influence on model results. The ICER remained cost-effective at a willingness to pay threshold of £20,000-£30,000/QALY in the majority of scenario analyses as well as in probabilistic sensitivity analysis, where onabotulinumtoxinA was cost-effective on 96{\%} of occasions at a threshold of £20,000/QALY and 98{\%} of occasions at £30,000/QALY. Conclusion: OnabotulinumtoxinA has been shown to reduce the frequency of headaches in patients with chronic migraine and can be considered a cost-effective use of resources in the UK National Health Service. The uncertainties in the model relate to the extrapolation of clinical data beyond the 56-week trial.",
keywords = "Chronic migraine, Cost effectiveness, OnabotulinumtoxinA, PREEMPT",
author = "Batty, {Anthony J.} and Hansen, {Ryan N.} and Bloudek, {Lisa M.} and Varon, {Sepideh F.} and Hayward, {Esther J.} and Pennington, {Becky W.} and Lipton, {Richard B.} and Sullivan, {Sean D.}",
year = "2013",
month = "7",
doi = "10.3111/13696998.2013.802694",
language = "English (US)",
volume = "16",
pages = "877--887",
journal = "Journal of Medical Economics",
issn = "1369-6998",
publisher = "Informa Healthcare",
number = "7",

}

TY - JOUR

T1 - The cost-effectiveness of onabotulinumtoxinA for the prophylaxis of headache in adults with chronic migraine in the UK

AU - Batty, Anthony J.

AU - Hansen, Ryan N.

AU - Bloudek, Lisa M.

AU - Varon, Sepideh F.

AU - Hayward, Esther J.

AU - Pennington, Becky W.

AU - Lipton, Richard B.

AU - Sullivan, Sean D.

PY - 2013/7

Y1 - 2013/7

N2 - Background: Although chronic migraine is associated with substantial disability and costs, few treatments have been shown to be effective. OnabotulinumtoxinA (Botox, Allergan Inc., Irvine, CA) is the first treatment to be licensed in the UK for the prophylaxis of headaches in adults with chronic migraine. This study aims to evaluate the cost-effectiveness of onabotulinumtoxinA in this indication in the UK. Methods: A state-transition (Markov) model was developed comparing onabotulinumtoxinA to placebo. Efficacy data and utility values were taken from the pooled Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical trials program (n = 1384). Estimates of resource utilisation were taken from the International Burden of Migraine Study (IBMS), and stopping rules were informed by published medical guidelines and clinical data. This study estimated 2-year discounted costs and quality-adjusted life years (QALYs) from the UK National Health Service perspective. Results: At 2 years, treatment with onabotulinumtoxinA was associated with an increase in costs of £1367 and an increase in QALYs of 0.1 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of £15,028. Treatment with onabotulinumtoxinA reduced headache days by an estimated 38 days per year at a cost of £18 per headache day avoided. Sensitivity analysis showed that utility values had the greatest influence on model results. The ICER remained cost-effective at a willingness to pay threshold of £20,000-£30,000/QALY in the majority of scenario analyses as well as in probabilistic sensitivity analysis, where onabotulinumtoxinA was cost-effective on 96% of occasions at a threshold of £20,000/QALY and 98% of occasions at £30,000/QALY. Conclusion: OnabotulinumtoxinA has been shown to reduce the frequency of headaches in patients with chronic migraine and can be considered a cost-effective use of resources in the UK National Health Service. The uncertainties in the model relate to the extrapolation of clinical data beyond the 56-week trial.

AB - Background: Although chronic migraine is associated with substantial disability and costs, few treatments have been shown to be effective. OnabotulinumtoxinA (Botox, Allergan Inc., Irvine, CA) is the first treatment to be licensed in the UK for the prophylaxis of headaches in adults with chronic migraine. This study aims to evaluate the cost-effectiveness of onabotulinumtoxinA in this indication in the UK. Methods: A state-transition (Markov) model was developed comparing onabotulinumtoxinA to placebo. Efficacy data and utility values were taken from the pooled Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical trials program (n = 1384). Estimates of resource utilisation were taken from the International Burden of Migraine Study (IBMS), and stopping rules were informed by published medical guidelines and clinical data. This study estimated 2-year discounted costs and quality-adjusted life years (QALYs) from the UK National Health Service perspective. Results: At 2 years, treatment with onabotulinumtoxinA was associated with an increase in costs of £1367 and an increase in QALYs of 0.1 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of £15,028. Treatment with onabotulinumtoxinA reduced headache days by an estimated 38 days per year at a cost of £18 per headache day avoided. Sensitivity analysis showed that utility values had the greatest influence on model results. The ICER remained cost-effective at a willingness to pay threshold of £20,000-£30,000/QALY in the majority of scenario analyses as well as in probabilistic sensitivity analysis, where onabotulinumtoxinA was cost-effective on 96% of occasions at a threshold of £20,000/QALY and 98% of occasions at £30,000/QALY. Conclusion: OnabotulinumtoxinA has been shown to reduce the frequency of headaches in patients with chronic migraine and can be considered a cost-effective use of resources in the UK National Health Service. The uncertainties in the model relate to the extrapolation of clinical data beyond the 56-week trial.

KW - Chronic migraine

KW - Cost effectiveness

KW - OnabotulinumtoxinA

KW - PREEMPT

UR - http://www.scopus.com/inward/record.url?scp=84879775220&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879775220&partnerID=8YFLogxK

U2 - 10.3111/13696998.2013.802694

DO - 10.3111/13696998.2013.802694

M3 - Article

VL - 16

SP - 877

EP - 887

JO - Journal of Medical Economics

JF - Journal of Medical Economics

SN - 1369-6998

IS - 7

ER -