Cost-effectiveness of abortive and preventative treatments in patients with migraine: a systematic review.

IF 2.7 3区医学 Q3 PHARMACOLOGY & PHARMACY

European Journal of Clinical Pharmacology Pub Date : 2025-10-01 Epub Date: 2025-07-15 DOI:10.1007/s00228-025-03881-z

Arefe Rashidi, Mohammadreza Keramati, Hadi Esmaily, Maryam Talebi, Ghader Mohammadnezhad

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引用次数: 0

Abstract

Background: Migraine imposes significant personal, societal, and economic burdens globally. Both abortive and preventative medications have evolved, yet their economic implications require further exploration, particularly for high-cost novel therapies such as calcitonin gene-related peptide (CGRP) inhibitors. This systematic review evaluates the cost-effectiveness of migraine interventions, focusing on both abortive and preventive interventions across diverse healthcare settings.

Methods: A systematic review was conducted to evaluate economic evaluations of migraine treatments published between 2014 and 2024. Inclusion criteria comprised full economic evaluations reporting incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs). Data extracted included country settings, perspectives, interventions compared, real-world data sources or economic models, and key outcomes.

Results: Of the 2172 unique records screened, 20 eligible peer-reviewed studies were included. Recent studies have focused on CGRP inhibitors, especially erenumab. However, BTX, anticonvulsants, surgery, simple analgesics, triptans, medical devices, and direct-site anesthetic/glucocorticoid injections are still discussed in some contexts. CGRP inhibitor monoclonal antibodies demonstrated ICERs ranging from 50,000 to 250,000 USD/QALY in high-income countries but often exceeded willingness-to-pay (WTP) thresholds in lower-resource settings. Preventive modalities like BTX were cost-effective for chronic migraine, with ICERs of 30,000-70,000 USD/QALY. Sensitivity analyses revealed that drug costs, adherence, and discount rates significantly influenced results.

Conclusion: Economic evaluations underscore the clinical benefits of novel migraine therapies but reveal price challenges, particularly in resource-limited settings. Biosimilar adoption and head-to-head cost comparisons are essential to improving access. Tailoring migraine management strategies to regional economic contexts remains critical to achieving sustainable and equitable care.

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流产和预防性治疗在偏头痛患者中的成本效益：一项系统综述。

背景：偏头痛在全球范围内给个人、社会和经济带来了巨大的负担。流产药物和预防药物都在不断发展，但它们的经济意义需要进一步探索，特别是对于高成本的新疗法，如降钙素基因相关肽（CGRP）抑制剂。本系统综述评估了偏头痛干预的成本效益，重点是在不同的医疗保健环境中进行流产和预防性干预。方法：对2014年至2024年间发表的偏头痛治疗的经济评价进行系统评价。纳入标准包括报告增量成本效益比（ICERs）和质量调整寿命年（QALYs）的完整经济评估。提取的数据包括国家背景、观点、比较的干预措施、真实世界的数据来源或经济模型以及主要结果。结果：在筛选的2172份独特记录中，包括20份符合条件的同行评审研究。最近的研究主要集中在CGRP抑制剂，特别是erenumab。然而，BTX、抗惊厥药、手术、简单镇痛药、曲坦类药物、医疗器械和直接部位麻醉/糖皮质激素注射在某些情况下仍被讨论。在高收入国家，CGRP抑制剂单克隆抗体的ICERs为5万至25万美元/QALY，但在低资源环境中，ICERs往往超过支付意愿（WTP）阈值。BTX等预防方式对慢性偏头痛具有成本效益，ICERs为3 -7万美元/QALY。敏感性分析显示，药物成本、依从性和折扣率显著影响结果。结论：经济评估强调了新型偏头痛疗法的临床效益，但也揭示了价格挑战，特别是在资源有限的情况下。生物仿制药的采用和直接成本比较对于改善获取至关重要。根据区域经济情况调整偏头痛管理战略对于实现可持续和公平的护理仍然至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Pharmacology 医学-药学

CiteScore

5.40

自引率

3.40%

发文量

170

审稿时长

3-8 weeks

期刊介绍： The European Journal of Clinical Pharmacology publishes original papers on all aspects of clinical pharmacology and drug therapy in humans. Manuscripts are welcomed on the following topics: therapeutic trials, pharmacokinetics/pharmacodynamics, pharmacogenetics, drug metabolism, adverse drug reactions, drug interactions, all aspects of drug development, development relating to teaching in clinical pharmacology, pharmacoepidemiology, and matters relating to the rational prescribing and safe use of drugs. Methodological contributions relevant to these topics are also welcomed. Data from animal experiments are accepted only in the context of original data in man reported in the same paper. EJCP will only consider manuscripts describing the frequency of allelic variants in different populations if this information is linked to functional data or new interesting variants. Highly relevant differences in frequency with a major impact in drug therapy for the respective population may be submitted as a letter to the editor. Straightforward phase I pharmacokinetic or pharmacodynamic studies as parts of new drug development will only be considered for publication if the paper involves -a compound that is interesting and new in some basic or fundamental way, or -methods that are original in some basic sense, or -a highly unexpected outcome, or -conclusions that are scientifically novel in some basic or fundamental sense.