Effect of Eptinezumab on Utility Scores in Patients with Migraine: Results from the DELIVER Study
Linus Jonsson1, Stephane A Regnier2, Steven Kymes2, Brian Talon3, Susanne F Awad2, Xin Ying Lee2, Peter J Goadsby4
1Department for Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 2H. Lundbeck A/S, 3Lundbeck LLC, 4NIHR-King’s Clinical Research Facility, King’s College London
Objective:
This post hoc analysis of the DELIVER clinical trial (NCT04418765) for the preventive treatment of migraine aims to communicate the impact of eptinezumab on health utility scores.
Background:
Cost-utility modeling informs reimbursement decisions and is based on the premise that health outcome improvements can be expressed as disease-independent utility scores. Previous cost-utility analyses of anti-calcitonin gene-related peptide therapies expressed the utility gain as a function of monthly migraine days (MMDs). Exploring the presence of an additional treatment effect on utility after controlling for MMDs can be insightful.
Design/Methods:
Utility scores were estimated using data from study visits at which the Migraine-Specific Quality of Life Questionnaire (MSQ) was completed. MSQ scores were then mapped to EQ-5D-3L using previously published algorithms. A linear mixed model evaluating the effect of eptinezumab compared to placebo using change from baseline at week 12 and 24, adjusted for MMDs, was generated, and a fixed intercept for each study arm was used to estimate if eptinezumab effected points compared to placebo beyond MMD reduction.
Results:
Analysis (n=1698 observations) of patients’ change from baseline in utility (Weeks 1‒24) revealed strong eptinezumab treatment effects relative to placebo, with the combined impact resulting in a gain of 0.09 points for eptinezumab compared to placebo (P<0.001). Score improvements were similar for eptinezumab 100 and 300 mg. After controlling for number of MMDs, eptinezumab patients had an additional utility increment of 0.056 (95% CI: 0.0382‒0.0742) relative to placebo patients.
Conclusions:
On average, patients treated with eptinezumab in DELIVER had a higher utility score than placebo patients, which is partially driven by the larger MMD reduction with eptinezumab treatment. However, these results also suggest that a treatment-specific utility impact exists in addition to MMD reduction. MMD reduction is not the sole driver of score improvement in migraine patients.