OBJECTIVES: Migraine is a neurological condition that can result in considerable functional disability. Individuals with higher migraine disease burden are candidates for preventive therapy. Galcanezumab and fremanezumab are Calcitonin Gene-Relate Peptide antagonists (aCGRP) indicated for migraine prevention. The cost-effectiveness of these two agents is unknown in patients with chronic migraine (CM) who have tried multiple preventive therapies, especially when the desired endpoint is “reversion to episodic migraine (EM)”.

METHODS: A cost-utility analysis (CUA) of galcanezumab compared to placebo—as well as fremanezumab compared to galcanezumab—was conducted in adult patients with chronic migraine with prior preventive treatment use. The projections were based on clinical trial outcomes and used a Markov model from a U.S. health care sector perspective. The model time horizon was two years with monthly transition cycles. Cost inputs included wholesale acquisition costs for the aCGRP agents ($477/month for galcanezumab and $485/month for fremanezumab, each with 27% estimated rebates), acute medication costs and emergency visit costs. The primary outcome was incremental cost-effectiveness ratio (ICER) in terms of the incremental cost change per quality-adjusted life year gained. Post-hoc analyses from Phase 3b trials reported “reversion to EM” in patients with CM.

RESULTS: Galcanezumab is projected to be cost-effective in individuals with chronic migraine who have tried multiple prior conventional agents when compared to placebo at annual cost of $23,504. (ICER = $5,937). Fremanezumab is projected to have a similar cost-effectiveness when compared to galcanezumab (ICER = $748.85). The projected results were most sensitive to the costs of galcanezumab and fremanezumab and to the probability of CM-EM reversion.

CONCLUSIONS: This is the first economic evaluation that projects cost-effectiveness of aCGRP agents for prevention of treatment-resistant migraine in context of CM-EM reversion. Both galcanezumab and fremanezumab are projected to be cost-effective in patients with CM to achieve reversion to EM.