Vo, Pamela

Abstract Objective To assess healthcare costs and healthcare resource utilization (HCRU) among adult patients who newly initiated erenumab in the United States. Methods This retrospective, non‐interventional analysis included adult patients (aged ≥18 years) newly initiating erenumab and who had three consecutive monthly claims for erenumab (11/1/2017–9/1/2019) from the Komodo Health database. Outcomes included migraine‐related and all‐cause costs, use of other preventive/acute migraine medications, and HCRU. All outcomes were compared during the 180‐day pre‐ versus the 180‐day post‐index periods. Cost outcomes were also assessed for longer periods including post‐index Days 91–270 and monthly mean post‐index costs for the longest time of continuous insurance enrollment. Results Overall, 1839 patients with migraine were included for analysis. Compared to the 180‐day pre‐index period, an increase in total migraine‐related costs (+$2639; p < 0.0001), migraine‐related prescription costs (+$3435, p < 0.0001), all‐cause total costs (+$2977; p < 0.001), and all‐cause prescription costs (+$4102; p < 0.0001) were observed during the 180‐day post‐index period after adjusting for covariates. Conversely, reduction in migraine‐related medical costs (−$896; p < 0.0001), and significantly lower odds of migraine‐related emergency room visits (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.44–0.82; p = 0.001), migraine‐related office visits (OR 0.58, 95% CI 0.53–0.64; p < 0.0001), and migraine‐related neurologist visits (OR 0.69, 95% CI 0.63–0.75; p < 0.0001) were observed during the 180‐days post‐index period. There were significant decreases in the odds of having overall preventive migraine medications (OR 0.81, 95% CI 0.75–0.87; p < 0.0001), acute‐migraine medications (OR 0.92, 95% CI 0.85–1.00; p = 0.038), and triptan (OR 0.79, 95% CI 0.73–0.85; p < 0.0001) during the 180‐day post‐index period. Sensitivity analyses on cost outcomes found no statistically significant differences in pre‐index migraine‐related costs compared to post‐index migraine‐related costs when assessing longer post‐index follow‐up periods. Conclusion Initiation of therapy with a novel treatment is often associated with an increase in overall healthcare costs due to the entrance costs associated with novel therapy. For a chronic condition such as migraine, cost versus health benefits should be evaluated over a long period (e.g., ≥2 years) to better understand the true benefits of therapy. Data from this study suggest that the entrance cost for erenumab, the primary driver of the high post‐index prescription costs gets mitigated by reduced medical costs over long‐term follow‐up. The results indicate better disease management in adult patients with migraine, which should be an important consideration for both patients and payors, as these findings have shown an offset between migraine‐related prescription and medical costs.

Background Migraine is associated with debilitating symptoms that can affect daily functioning. “My Migraine Voice” was a large, cross‐sectional, multi‐country online survey aimed at understanding disease burden directly from people with migraine. Objective This study reports on the social and economic impacts of migraine, specifically the impact on activities of daily living and the costs of migraine, from the point of view of people with migraine in the United States. Methods The online survey was administered to adults with a self‐reported diagnosis of migraine who experienced 4 or more monthly migraine days each month for the previous 3 months. Prespecified screening quotas were used so that 90% of respondents reported current or past use of preventive migraine medication, 80% of whom switched treatment (ie, changed their prescribed preventive medication at least once). The remaining 10% were preventive treatment naïve (ie, never used any prescribed preventive medication). Burden of migraine on activities of daily living and caregivers (eg, functional limitations, fear of next migraine attack, sleep problems) and economic burden (eg, out‐of‐pocket costs, impact on work productivity using the validated work productivity and activity impairment questionnaire) reported by respondents from the United States are presented. Results are stratified by employment status, migraine frequency (chronic vs episodic migraine), and history of preventive treatment. Results Thousand hundred and one individuals with migraine from the United States responded to the survey. Respondents reported limitations completing daily activities during all migraine phases, including during the premonitory/aura and postdrome phases. Most (761/1101 (69%)) relied on family, friends, or others for help with daily tasks and reported being helped a median of 9 days (25th percentile 5 days, 75th percentile 15 days) within the last 3 months. Respondents with chronic migraine reported being helped for more days (median 10 days, 25th percentile 5 days, 75th percentile 23 days) in the last 3 months. Almost all (962/1101 (87%)) experienced sleep difficulties and 41% (448/1101) (48% (336/697) of those with 2 or more preventive treatment failures) were very or extremely fearful of a next migraine attack. Median (25th percentile, 75th percentile) monthly out‐of‐pocket costs of $90.00 ($30.00, $144.00) in doctor’s fees (n = 504), $124.00 ($60.00, $234.00) in health insurance (n = 450), $40.00 ($20.00, $100.00) for prescriptions (n = 630), and $50.00 ($0.00, $100.00) for complementary therapies (n = 255) were reported. Those with 2 or more preventive treatment failures reported higher monthly out‐of‐pocket doctor fees (median $99.00 ($30.00, $150.00), n = 388). Among employed respondents (n = 661), migraine resulted in 22% absenteeism, 60% presenteeism, 65% work productivity loss, and 64% activity impairment. Conclusions Migraine impacts individuals’ activities of daily living, work‐life, and financial status, especially individuals with high needs, namely those with 4 or more monthly migraine days and prior treatment failures. People with migraine are impaired during all migraine phases, experience fear of their next migraine attack and sleep difficulties, and pay substantial monthly out‐of‐pocket costs for migraine. Burden is even greater among those who have had 2 or more preventive treatment failures. Impacts of migraine extend beyond probands to caregivers who help people with migraine with daily tasks, employers who are affected by employee absenteeism, presenteeism, and reduced productivity, and society which is burdened by lost and reduced economic productivity and healthcare costs.