Economic Impact of Early Vs. Late Initiation of Atogepant for The Preventive Treatment of Migraine
Jessica Ailani1, Anjana Lalla2, Pranav Gandhi2, Karen Carr2, Brett Dabruzzo2, Rashmi Halker Singh3, Richard Lipton4
1Medstar Georgetown Neurology, 2AbbVie, 3Mayo Clinic, 4Department of Neurology and the Montefiore Headache Center, Albert Einstein College of Medicine
Objective:
Evaluate the economic impact of removing step edits prior to initiating atogepant for the preventive treatment of migraine, from a US payor perspective.
Background:
Atogepant is an oral calcitonin gene-related peptide receptor (CGRP) antagonist approved for the preventive treatment of migraine. US payors typically require 1- or 2-step edits of non-specific oral generic preventive medications before allowing access to atogepant.
Design/Methods:
An Excel-based economic model was developed to estimate 1-year direct cost savings associated with removing step edits before access to atogepant from a US payor’s perspective. Efficacy in the model was assessed 2 months after treatment initiation using 50% responder rate data derived from a previously published network meta-analysis of atogepant versus CGRP monoclonal antibodies and oral generics. Direct costs included wholesale acquisition costs of preventive and acute migraine treatments, neurologist and administrative cost per step edit, and migraine-related healthcare resource utilization (HCRU) costs. Patients who failed current oral generic treatment (non-responders) moved to the next oral generic or atogepant. After each step edit, non-responders may stop seeking preventive treatment, returning to their baseline migraine burden and incurring high HCRU and acute medication costs for the remaining time horizon.
Results:
Total annual direct costs for patients who have 2-step edits, 1-step edit, and 0-step edits were calculated as $12,120, $11,863, and $10,839, respectively. The biggest driver for cost savings was associated with migraine-related HCRU leading to an annual costs savings of $1281 per patient when reducing from 2-step edits to 0-step edits. Reducing 1-step edit to 0-step edits resulted in annual costs savings of $1024 per patient.
Conclusions:
Reducing 2-step edits / 1-step edit to 0-step edits for atogepant demonstrated annual cost savings of more than $1,000 per patient for US payors. These model-based estimates should be assessed in randomized trials of benefit designs.
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