Updated cost-effectiveness analysis of onabotulinumtoxinA for the prevention of headache in adults with chronic migraine who have previously received three or more preventive treatments in the UK

Hollier-Hann, G.; Curry, Alistair S; Onishchenko, Kateryna; Akehurst, Ron; Ahmed, Fayyaz; Davies, Brendan; Keyzor, Ian

doi:10.1080/13696998.2019.1675417

Cited by 16 publications

(42 citation statements)

References 28 publications

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“…When compared with oral migraine preventive medications, onabotulinumtoxinA was associated with a significantly lower likelihood of headache-related emergency department visits and hospitalizations in a large, United States healthcare claims database study [ 31 ]. Additionally, cost-effectiveness analyses have shown that onabotulinumtoxinA is a cost-effective treatment for chronic migraine in the UK [ 20 , 32 ], Sweden and Norway [ 33 ], and Italy [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…The PREEMPT phase 3 clinical trial program provided evidence of the efficacy and safety of onabotulinumtoxinA for headache prevention [ 12 , 13 ] and these findings are well supported by both clinical and real-world studies [ 14 – 19 ]. Additionally, cost modeling, using patient data and dosing protocols from the PREEMPT clinical trials, EuroQol 5-Dimension Questionnaire (EQ-5D) utility estimates from the REPOSE study, and resource utilization estimates the International Burden of Migraine Study (IBMS) has demonstrated that onabotulinumtoxinA is likely to represent a cost-effective resource in the UK [ 20 ]. To establish the complete treatment benefit across different countries and healthcare systems, additional real-world data on the economic impact of onabotulinumtoxinA treatment for CM is needed.…”

Section: Introductionmentioning

confidence: 99%

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Real-life use of onabotulinumtoxinA reduces healthcare resource utilization in individuals with chronic migraine: the REPOSE study

et al. 2021

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Background Chronic migraine (CM) is associated with substantial economic burden. Real-world data suggests that onabotulinumtoxinA treatment for CM reduces healthcare resource utilisation (HRU) and related costs. Methods REPOSE was a 2-year prospective, multicentre, non-interventional, observational study to describe the real-world use of onabotulinumtoxinA in adult patients with CM. This analysis examined the impact of onabotulinumtoxinA on HRU. Patients received onabotulinumtoxinA treatment approximately every 12 weeks according to their physicians’ discretion, guided by the summary of product characteristics (SPC) and PREEMPT injection paradigm. HRU outcome measures were collected at baseline and all administration visits and included headache-related hospitalizations and healthcare professional (HCP) visits. Health economic data, including family doctor and specialist visits, inpatient treatment for headache, acupuncture, technical diagnostics, use of nonpharmacologic remedies, and work productivity were also collected for patients enrolled at German study centres. Results Overall, 641 patients were enrolled at 78 study centres across 7 countries (Germany, UK, Italy, Spain, Norway, Sweden, and Russia), 633 received ≥1 onabotulinumtoxinA dose, and 128 completed the 2-year study. Patients were, on average, aged 45 years, 85% were female, and 60% (n = 377) were from Germany. At the end of the 2-year observation period, significantly fewer patients reported headache-related hospitalizations (p < 0.02) and HCP visits (p < 0.001) within the past 3 months than in the 3 months before baseline. In the German population, reductions were observed across all health services at all follow-up visits compared with baseline. The percentage of patients who saw a family doctor decreased from 41.7% at baseline to 13.5% at administration visit 8 and visits to a medical specialist decreased from 61.7% to 5.2% of patients. Inpatient acute treatment and technical diagnostics declined from 6.4% and 19.7% of patients at baseline to 0.0% and 1.0% at administration 8, respectively. The use of nonpharmacologic remedies and medication for the acute treatment of migraine also decreased with continued onabotulinumtoxinA treatment. Work incapacity, disability, absenteeism, and impaired performance at school/work improved with onabotulinumtoxinA treatment for CM over the 2-year observation period. Conclusions Real-world evidence from REPOSE demonstrates that onabotulinumtoxinA treatment is associated with decreased HRU and supports the long-term benefits associated with the use of onabotulinumtoxinA for CM in clinical practice. Trial registration NCT01686581. Name of registry: ClinicalTrials.gov. URL of registry: Date of retrospective registration: September 18, 2012. Date of enrolment of first patient: July 23, 2012.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real-life use of onabotulinumtoxinA reduces healthcare resource utilization in individuals with chronic migraine: the REPOSE study

et al. 2021

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“…A review of these evaluations may provide additional insights for developing a novel economic evaluation of migraine therapies. In the time since the SLR was completed, we identified an update to the cost-effectiveness model of onabotulinumtoxinA for the prevention of headache in adults with chronic migraine 21 . However, this update was to incorporate new EQ-5D utility estimates, and there were no novel changes to the model structure.…”

Section: Discussionmentioning

confidence: 99%

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

Mahon

Huels

Hacking

et al. 2020

Journal of Medical Economics

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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.

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“…When including indirect costs the ICER was reduced to GBP 9422 [ 24 ]. An updated analysis resulted in an ICER of GBP 16,306, in CM patients who have previously failed at least three preventive treatments [ 25 ]. In 2014, an Italian study comparing Botox to placebo in patients with CM estimated an ICER of EUR 9407, assuming a 2-year time horizon and not including indirect costs.…”

Section: Discussionmentioning

confidence: 99%

“…While previous cost-effectiveness (CE) analyses of Botox in chronic migraine have been conducted in the United Kingdom (UK) [ 24 , 25 ] and Italy [ 26 ] there is a lack of Nordic CE studies. CE outcomes are highly dependent on country specific factors such as e.g.…”

Section: Introductionmentioning

confidence: 99%

Economic consequences of migraine in Sweden and implications for the cost-effectiveness of onabotulinumtoxinA (Botox) for chronic migraine in Sweden and Norway

Hedblom

Axelsson

Jacobson³

et al. 2020

J Headache Pain

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Background Migraine is a common and incapacitating condition, with severe impact on the quality of life (QoL) of the afflicted and their families, and negative economic consequences through decreased workforce participation, reduced functional ability and elevated healthcare costs. This study aimed to describe the economic consequences of migraine in Sweden using cost of illness survey data and, based on this data, assess the cost-effectiveness of onabotulinumtoxinA (Botox) for the treatment of chronic migraine in Sweden and Norway. Methods A survey study was conducted in Swedish migraine patients, with questions on patient characteristics, headache frequency and severity, effect on daily activities and work, QoL, health resource utilization, and medication use. Resulting costs were estimated as annual averages over subgroups of average monthly headache days. Some results were used to inform a Markov cost-effectiveness chronic migraine model. The model was adapted to Sweden and Norway using local data. The analysis perspective was semi-societal. Results’ robustness was tested using one-way, structural, and probabilistic sensitivity analyses. Results Results from the cost of illness analysis ( n = 454) indicated a clear correlation between decreased QoL and increased costs with increasing monthly headache days. Total annual costs ranged from EUR 6221 in patients with 0–4 headache days per month, to EUR 57,832 in patients with 25–31. Indirect costs made up the majority of costs, ranging from 82% of total costs in the 0–4 headache days group, to 91% in 25–31 headache days. The cost-effectiveness analyses indicated that in Sweden, Botox was associated with 0.223 additional QALYs at an additional cost of EUR 4126 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of EUR 18,506. In Norway, Botox was associated with 0.216 additional QALYs at an additional cost of EUR 4301 compared to placebo, resulting in an ICER of EUR 19,954. Conclusions In people with migraine, an increase in monthly headache days is clearly related to lower QoL and higher costs, indicating considerable potential costs-savings in reducing the number of headache days. The main cost driver for migraine is indirect costs. Botox reduces headache days and is a cost-effective treatment for chronic migraine in Sweden and Norway.

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Updated cost-effectiveness analysis of onabotulinumtoxinA for the prevention of headache in adults with chronic migraine who have previously received three or more preventive treatments in the UK

Cited by 16 publications

References 28 publications

Real-life use of onabotulinumtoxinA reduces healthcare resource utilization in individuals with chronic migraine: the REPOSE study

Real-life use of onabotulinumtoxinA reduces healthcare resource utilization in individuals with chronic migraine: the REPOSE study

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

Economic consequences of migraine in Sweden and implications for the cost-effectiveness of onabotulinumtoxinA (Botox) for chronic migraine in Sweden and Norway

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