OBJECTIVES: To evaluate the cost-effectiveness of eptinezumab as a preventive treatment of migraine in patients with episodic migraine (EM).

METHODS: A hybrid decision-Markov model was constructed to access the cost-effectiveness of eptinezumab as a preventive treatment for migraines compared to erenumab among EM patients from the United States (US) healthcare payer’s perspective. A decision tree model was constructed to simulate the probability of patients experiencing more than 50% reduction in monthly migraine days for six months after therapy initiation. The Markov model was conducted over a 10-year horizon and consisted of three states: “Off Preventive Treatment”, “Preventive Treatment”, and death. Subjects entered the Markov model in either the “Preventive Treatment” or “Off Preventive Treatment” state. Eptinezumab and erenumab costs were based on the US Veteran Affairs Federal Supply Schedule prices. Probabilities and utility scores were based on published literature. Total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) were calculated, and a probabilistic sensitivity analysis (PSA) was performed. A cost-effectiveness acceptability curve was created to evaluate the probability of each strategy’s cost-effectiveness across a willingness-to-pay (WTP) threshold between $0 and $100,000 per QALY gained.

RESULTS: In the base-case results, the total costs for eptinezumab and erenumab were $3459 and $1491. Total QALYs for eptinezumab and erenumab were 5.93 and 5.83. Base-case ICER was $19,126 per QALY gained. In the PSA, total costs for eptinezumab and erenumab were $3481 (95% CrI: 1755, 6094) and $1414 (95% CrI: 540, 2903). Total QALYs for eptinezumab and erenumab were 5.93 (95% CrI: 4.12, 7.29) and 5.82 (95% CrI: 4.36, 7.31). ICER was $19,753 per QALY gained.

CONCLUSIONS: Eptinezumab was cost-effective at a WTP threshold that was greater than $19,753 per additional QALY gained; however, the probability of cost-effectiveness was slightly higher than the indifference level of 50%.