Georgia Hollier-Hann1, Alistair Curry1, Kateryna Onishchenko2, Ron Akehurst3, Fayyaz Ahmed4,5, Brendan Davies6, Ian Keyzor2. 1. SIRIUS Market Access Ltd, Newcastle upon Tyne, UK. 2. Allergan UK, Marlow, UK. 3. BresMed, Sheffield, UK. 4. Spire Hesslewood Clinic, Hessel, UK. 5. Hull York Medical School, Hull, UK. 6. Midlands Regional Headache Clinic, University Hospital of North Midlands, Stoke-on-Trent, UK.
Abstract
Aims: OnabotulinumtoxinA is recommended by NICE for the treatment of chronic migraine. This economic evaluation provides updated estimates of the cost-effectiveness of onabotulinumtoxinA for chronic migraine using new utility estimates in an existing model structure. Methods: A previously published model was revised to include EQ-5D utility estimates from a large observational study (REPOSE; n = 633). Efficacy data were taken from the pooled phase III PREEMPT clinical trial program, while resource utilization estimates were obtained from the International Burden of Migraine Study (IBMS). The model estimated costs and quality-adjusted life years (QALYs) gained over 2 years from the UK NHS perspective. Results: OnabotulinumtoxinA treatment resulted in total discounted incremental costs of £1,204 and an incremental discounted QALY gain of 0.07 compared with placebo in patients with chronic migraine who have previously failed three or more preventive treatments, corresponding to an incremental cost-effectiveness ratio (ICER) of £16,306 per QALY gained. Scenario analysis showed that the administration of onabotulinumtoxinA by a specialist nurse rather than a neurology consultant reduced the ICER from £16,306 to £13,832 per QALY gained. Removal of the positive stopping rule recommended in current NICE guidance increased the ICER to £20,768 per QALY for onabotulinumtoxinA vs. placebo. Combining these two scenarios produced an ICER of £17,686 per QALY gained. Conclusion: NICE recommended onabotulinumtoxinA for the prevention of chronic migraine in 2012 amid concerns about the uncertainty of ICER estimates, with a positive stopping rule used to manage some of these uncertainties. Since the publication of the NICE guidance, the REPOSE study provides a more recent source of utility data based on real-world evidence. The results of analyses including these utilities suggest that the application of the positive stopping rule may not be necessary to ensure cost-effectiveness and that this aspect of the current NICE guidance for onabotulinumtoxinA may merit reconsideration.
Aims: OnabotulinumtoxinA is recommended by NICE for the treatment of chronic migraine. This economic evaluation provides updated estimates of the cost-effectiveness of onabotulinumtoxinA for chronic migraine using new utility estimates in an existing model structure. Methods: A previously published model was revised to include EQ-5D utility estimates from a large observational study (REPOSE; n = 633). Efficacy data were taken from the pooled phase III PREEMPT clinical trial program, while resource utilization estimates were obtained from the International Burden of Migraine Study (IBMS). The model estimated costs and quality-adjusted life years (QALYs) gained over 2 years from the UK NHS perspective. Results: OnabotulinumtoxinA treatment resulted in total discounted incremental costs of £1,204 and an incremental discounted QALY gain of 0.07 compared with placebo in patients with chronic migraine who have previously failed three or more preventive treatments, corresponding to an incremental cost-effectiveness ratio (ICER) of £16,306 per QALY gained. Scenario analysis showed that the administration of onabotulinumtoxinA by a specialist nurse rather than a neurology consultant reduced the ICER from £16,306 to £13,832 per QALY gained. Removal of the positive stopping rule recommended in current NICE guidance increased the ICER to £20,768 per QALY for onabotulinumtoxinA vs. placebo. Combining these two scenarios produced an ICER of £17,686 per QALY gained. Conclusion: NICE recommended onabotulinumtoxinA for the prevention of chronic migraine in 2012 amid concerns about the uncertainty of ICER estimates, with a positive stopping rule used to manage some of these uncertainties. Since the publication of the NICE guidance, the REPOSE study provides a more recent source of utility data based on real-world evidence. The results of analyses including these utilities suggest that the application of the positive stopping rule may not be necessary to ensure cost-effectiveness and that this aspect of the current NICE guidance for onabotulinumtoxinA may merit reconsideration.
Authors: Gemma E Shields; Mark Wilberforce; Paul Clarkson; Tracey Farragher; Arpana Verma; Linda M Davies Journal: Pharmacoeconomics Date: 2021-10-29 Impact factor: 4.981
Authors: Raffaele Ornello; Carlo Baraldi; Fayyaz Ahmed; Andrea Negro; Anna Maria Miscio; Antonio Santoro; Alicia Alpuente; Antonio Russo; Marcello Silvestro; Sabina Cevoli; Nicoletta Brunelli; Fabrizio Vernieri; Licia Grazzi; Luca Pani; Anna Andreou; Giorgio Lambru; Ilaria Frattale; Katharina Kamm; Ruth Ruscheweyh; Marco Russo; Paola Torelli; Elena Filatova; Nina Latysheva; Anna Gryglas-Dworak; Marcin Straburzyński; Calogera Butera; Bruno Colombo; Massimo Filippi; Patricia Pozo-Rosich; Paolo Martelletti; Simona Guerzoni; Simona Sacco Journal: Int J Environ Res Public Health Date: 2022-09-02 Impact factor: 4.614