OBJECTIVES: To assess the cost-effectiveness of erenumab 140 mg, topiramate, and placebo for the prophylactic treatment of episodic migraine and chronic migraine in Spain.

METHODS: We developed a cost-effectiveness analysis using a Markov model with a 10-year time horizon based on responder patients. Patients included in the model were adults (mean age of 41 years and 80.5% female) who had 4 episodes or more of monthly migraine days (MMD) with one or more prior preventive treatment failed. A responder was defined as having a minimum 50% reduction in the number of MMDs. Efficiency score was cost per quality-adjusted life year (QALY) gained and cost per MMD avoided. Resources use and costs (2022) were obtained from official data sources and validated by an expert panel, and clinical outcomes came from the erenumab clinical trials (NCT02066415, STRIVE, ARISE, LIBERTY and HER-MES). Both health-care payer and societal perspectives were included. We performed a deterministic and probabilistic sensitivity analysis to validate the robustness of the model.

RESULTS:

At 10-years, QALYs were 4.66/5.85 for placebo, 4.92/5.88 for topiramate and 5.40/6.11 erenumab for chronic and episodic migraine, respectively. Erenumab showed an incremental cost per patient of 2.895€ vs placebo and 4.224€ vs topiramate for chronic migraine patients; and an incremental cost of 4.800€ vs placebo and 4.948€ vs topiramate for episodic migraine, from the health-care perspective. Patients treated with erenumab achieved a reduction of 359-552 MMDs between for chronic migraine and 172-198 MMDs for episodic migraine. Cost per QALY of erenumab was lower than the Spanish efficiency threshold for all perspectives. Cost per MMDs avoided with erenumab was below 30€. Probabilistic sensitivity analysis confirmed the results.

CONCLUSIONS:

Erenumab (Aimovig®) reduced MMDs more than a placebo and topiramate with a lower discontinuation rate. Erenumab (Aimovig®) is a cost-effective alternative for chronic and episodic migraine in Spain.