Economic evaluations in migraine: systematic literature review and a novel approach

Abstract

Background: For novel migraine therapies, economic evaluations will be required to understand the trade-offs between additional health benefit and additional cost. The purpose of this study was to conduct a systematic literature review (SLR) to identify previous economic evaluations in migraine from the United Kingdom or Irish perspective to critically appraise these evaluations and to propose, if necessary, a novel modelling approach that can be used for future economic evaluations of migraine therapies. Methods: An SLR was conducted to identify previous economic evaluations of preventive migraine treatments. Key opinion leaders were consulted to determine the criteria for a robust migraine economic evaluation. Economic evaluations identified in the SLR were appraised against these criteria, and a novel cost-effectiveness model structure was then proposed. Results: Eight records reporting on published economic evaluations were identified and critically appraised for general quality. Expert consultation provided 6 recommendations on the ideal model structure for migraine that is both clinically and economically meaningful. A decision-tree plus Markov structure was then developed as a cost-effectiveness model for migraine therapies where each health state is associated with a patient distribution across monthly migraine day (MMD) frequencies. Conclusions: Future migraine economic evaluations should allow for assessments across the full spectrum of migraine, a response-based stopping rule, and the estimation of benefits and resource costs based on MMD frequency. The approach proposed in this paper captures all of the desired elements for an economic evaluation of migraine therapy and is suitable to assess new migraine therapies.

Monthly migraine days, tablet utilization, and quality of life associated with Rimegepant – post hoc results from an open label safety study (BHV3000–201)

“…Tracking MMD and tablet utilization over a one-year period is a strength as opposed to a single-dose study design where outcomes cannot be tracked over time. There are some advantages to modeling MMD frequency as a continuous outcome, including improved retention of information, increased accuracy of outcome estimates, and between groups comparisons [ 29 ].…”

“…To optimize healthcare resource management, a three-dimensional approach that considers clinical, humanistic and economic outcomes is necessary [ 28 ]. Therefore, economic evaluations of migraine treatments require a model that tracks MMD frequency and captures the impact of change in MMD frequency as a result of treatment on resource utilization and QALYs [ 29 ].…”

Epigenetic Connection of the Calcitonin Gene-Related Peptide and Its Potential in Migraine

“…The latter can be further divided into housekeeping ncRNAs, such as ribosomal RNA (rRNA) and transfer RNA (tRNA), and regulatory ncRNAs, which can be classified into short non-coding RNA (snRNA, fewer than 200 nucleotides in length) and long non-coding RNA (more than 200 nucleotides). This is not a subject of this review; detailed information on the classification and general properties of non-coding RNAs can be found elsewhere, e.g., [ 6 , 90 , 91 ]. We will limit our considerations to micro RNA (miRNA), circular RNA (circRNA), and long non-coding RNA (lncRNA).…”

“…Introducing these drugs to the market was a breakthrough in migraine prevention and therapy—they display very high efficacy and tolerability, as shown in recent real-world studies [ 3 , 4 , 5 ]. However, even if other health cost savings may compensate for the high cost of antibodies targeting the CGRP pathway, an increase in their direct costs remains the main drawback of their use [ 6 ].…”

Multinational descriptive analysis of the real‐world burden of headache using the Migraine Buddy application

“…Despite considerable advances in the understanding of migraine and substantial advances in treatment, under‐treatment remains a global issue [ 1 , 4 , 5 ]. Coupled with the large cost burden on healthcare, there is a pressing need to improve headache management [ 6 , 7 ].…”