Cost-effectiveness of abortive and preventative treatments in patients with migraine: a systematic review

Migraine imposes significant personal, societal, and economic burdens globally. Both abortive and preventative medications have evolved, yet their economic implications require further exploration, particularly for high-cost novel therapies such as calcitonin gene-related peptide (CGRP) inhibitors. This systematic review evaluates the cost-effectiveness of migraine interventions, focusing on both abortive and preventive interventions across diverse healthcare settings.

A systematic review was conducted to evaluate economic evaluations of migraine treatments published between 2014 and 2024. Inclusion criteria comprised full economic evaluations reporting incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs). Data extracted included country settings, perspectives, interventions compared, real-world data sources or economic models, and key outcomes.

Of the 2172 unique records screened, 20 eligible peer-reviewed studies were included. Recent studies have focused on CGRP inhibitors, especially erenumab. However, BTX, anticonvulsants, surgery, simple analgesics, triptans, medical devices, and direct-site anesthetic/glucocorticoid injections are still discussed in some contexts. CGRP inhibitor monoclonal antibodies demonstrated ICERs ranging from 50,000 to 250,000 USD/QALY in high-income countries but often exceeded willingness-to-pay (WTP) thresholds in lower-resource settings. Preventive modalities like BTX were cost-effective for chronic migraine, with ICERs of 30,000-70,000 USD/QALY. Sensitivity analyses revealed that drug costs, adherence, and discount rates significantly influenced results.

Economic evaluations underscore the clinical benefits of novel migraine therapies but reveal price challenges, particularly in resource-limited settings. Biosimilar adoption and head-to-head cost comparisons are essential to improving access. Tailoring migraine management strategies to regional economic contexts remains critical to achieving sustainable and equitable care.