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Published on: June 2, 2014
Cost-utility analysis of erenumab preventive treatment for chronic migraine in China
Lijiang Wang1, Menglu Zhu1, Qingqing Hu1
1Department of Pharmacy, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China.
Objective:
This study aimed to evaluate the cost-utility of erenumab preventive treatment compared to no preventive treatment in adults with chronic migraine in China.
Methods:
An individual-level microsimulation model was developed from the perspective of the Chinese health system. The model compared erenumab 70 mg every 4 weeks with no preventive pharmacotherapy plus usual acute and migraine-related medical care. The base-case time horizon was 52 weeks, with 13 cycles of 4 weeks each. Clinical inputs were mainly derived from the DRAGON trial, which included Asian adults with chronic migraine. Week 12 monthly migraine days (MMDs) distributions were calibrated to reproduce the reported mean MMD and ≥50% MMD responder rate. Post-week 12 outcomes in the erenumab arm were extrapolated at the patient level according to treatment status and discontinuation. Costs included erenumab acquisition, acute medications, and migraine-related non-drug medical services. Outcomes included total costs, quality-adjusted life years (QALYs), the incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB). One-way sensitivity analysis, probabilistic sensitivity analysis, a 12-week-horizon scenario analysis, and threshold price analysis were conducted.
Results:
In the base case, erenumab preventive treatment generated 0.572 QALYs at a total cost of CNY 45,810.21, whereas no preventive treatment generated 0.557 QALYs at a total cost of CNY 4,281.59. The incremental cost was CNY 41,528.62, and the incremental QALY gain was 0.015. The ICER was CNY 2,830,387.52 per QALY gained. The INMB was CNY - 40,066.30 and CNY - 37,141.64 at willingness-to-pay (WTP) thresholds of 1× and 3× Gross Domestic Product (GDP) per capita, respectively. Sensitivity analyses and the 12-week scenario analysis supported the base-case conclusion. Threshold price analysis showed that erenumab would need to decrease to CNY 141.82 and CNY 386.81 per 70-mg box to be cost-effective at WTP thresholds of 1× and 3× GDP per capita, respectively.
Conclusion:
From the Chinese health system perspective, erenumab as preventive treatment provides modest health gains for adults with chronic migraine but is unlikely to be cost-effective at its current price.
