Cost impact of a non-invasive, portable device for patient self-administration of chronic migraine in a UK National Health Service setting

Abstract

BackgroundChronic migraine (CM) is a neurological disorder associated with substantial disability. Botulinum toxin type A (Botox) is an approved and effective preventive treatment option for adult patients with CM. Transcranial magnetic stimulation (TMS) is an alternative treatment device delivering a brief pre-set magnetic pulse used for self-administration by the patient at home. Despite being available in a risk share scheme TMS is perceived to be more costly in the UK. The objective of this study was to analyse the incremental costs of TMS compared to Botox in refractory CM patients both for a UK individual funding request setting as well as for an average UK specialist center setting.MethodsCost impact results were derived from a decision-tree model simulating treatment pathways over 1 year. Costs were applied from the most recently available UK data sources. Sensitivity analysis was performed for all variables.ResultsBased on published utilisation data 45.5 % of CM patients would continuously receive Botox over 1 year, whereas 53.7 % of TMS patients would be still on treatment at the end of year one. Total costs of Botox treatment accrue to £2923 in an individual funding request NHS cost setting, whereas TMS treatment results in £1466 in the first year. Applying a time-based NHS cost setting expenditures accrue to £1747 for the Botox treatment and to £1361 for the TMS treatment. In both cost settings variation of cost assumptions did have a minor impact on the cost increment from Botox to TMS.ConclusionThe current risk share based remuneration model of TMS allows the UK NHS to reimburse only the cost of those patients experiencing reduction in migraine days resulting in lower costs for treating migraine attacks. Treatment of chronic refractory migraine using TMS implies a substantial cost reduction potential for the management of chronic treatment of refractory migraine patients compared to conventional Botox treatment.

Non-Pharmacological Approaches for Migraine

“…A total of 190 patients, using the device for acute and preventive purposes, reported an overall 60% pain relief rate as well as significant reduction of headache days after 3 months of continuous treatment. An economic comparison between sTMS and Botox® treatment in chronic migraine in the UK also suggests that sTMS offers a cost effective treatment for this group of patients [ 60 ].…”

Single-Pulse Transcranial Magnetic Stimulation for the preventive treatment of difficult-to-treat migraine: a 12-month prospective analysis

“…However, about 40% of patients do not report a satisfactory response. Moreover, BoNTA has been shown to be more expensive than sTMS on the UK NHS and with regular three-monthly administration regimen, may put long-term unsustainable pressure on headache clinics due long-term capacity issues, leaving some patients without treatment continuity [ 28 ]. For BoNTA non-responders who have also failed three classes of medications, evidence-based treatments with sustained long term follow-up data are very limited [ 24 ].…”

Possibilities of Using Transcranial Magnetic Stimulation for Migraine

“…В исследовании, опубликованном в 2016 г. ученым Bruggenjurgen B. с соавторами изучены механизмы воздействия высокочастотной рТМС (10 Гц, 600 последовательностей) на фронтальную область левого полушария головного мозга у пациентов с мигренью. По данным соматосенсорных вызванных потенциалов у пациентов после курса рТМС было установлено повышение габитуации (привыкания) реакции корковых нейронов, что способствует снижению болевого синдрома [25].…”