Health care resource utilization and direct costs incurred over 12 months by patients with migraine initiating self-injectable calcitonin gene-related peptide monoclonal antibodies: A US real-world study.

Background: Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are approved for migraine prevention. Limited information is available comparing the health care resource utilization (HCRU) and direct costs associated with initiating different CGRP mAbs.

Objective: To compare all-cause and migraine-related HCRU and direct costs in US patients with migraine initiating the self-injectable CGRP mAbs, galcanezumab, fremanezumab, or erenumab.

Methods: This retrospective cohort study used data from Merative Marketscan Commercial and Medicare Databases. Adults with at least 1 claim (first claim=index) for the above CGRP mAbs between May 2018 and September 2020 (index period), with continuous enrollment for 12 months pre-index (baseline [BL]) and post-index (follow-up [FU]) were included. Patients with a claim for index drug during BL were excluded. Mean HCRU and mean total costs (inpatient, outpatient, and outpatient pharmacy costs) were evaluated over 12 months post-index. Propensity score matching was used to balance the galcanezumab vs fremanezumab (2:1) and galcanezumab vs erenumab (1:1) cohorts. P values of <0.05 were considered statistically significant.

Results: After matching, patient demographics and clinical characteristics were similar between galcanezumab vs fremanezumab (n=2,674 sets) and galcanezumab vs erenumab (n=3,503 sets) cohorts. Relative to BL, numerically lower all-cause and migraine-related HCRU (inpatient and outpatient visits) were observed in all cohorts over the 12-month post-index period, whereas outpatient pharmacy HCRU was numerically higher. All-cause and migraine-related total costs (mean) were higher over the FU period in all cohorts (all P < 0.001). Mean all-cause and migraine-related cost increases were numerically similar for galcanezumab vs fremanezumab ($503 vs $518 [P=0.825] and $467 vs $468 [P=0.990]), and for galcanezumab vs erenumab ($504 vs $499 [P=0.934] and $462 vs $443 [P=0.375]). Outpatient pharmacy costs contributed greatly to migraine-related costs, whereas all-cause costs were greatly driven by outpatient costs.

Conclusions: HCRU and direct cost differences observed at 12 months following initiation of self-injectable CGRP mAbs for migraine prevention were numerically similar across cohorts for patients treated with galcanezumab, fremanezumab, and erenumab. More work should be done to learn if these drugs perform differently with respect to other important factors not examined here.