The Effects of Calcitonin Gene-Related Peptide Inhibitors on Migraine Days, Healthcare Use, and Workplace Productivity: A Markov Model Approach

Migraine is a debilitating condition in which painful headaches occur frequently.  Treatments for migraines, such as acute care treatment and preventive therapy, can help migraine sufferers manage their pain and reduce their frequency. However, there have been few recent improvements in the market for preventive migraine therapies.  Calcitonin gene-related peptide (CGRP) inhibitors are a new class of preventive migraine drugs that may address the need for new, effective treatments for migraines.

In this study, we estimate the value of CGRP inhibitor treatment for chronic and episodic migraine sufferers. We used a Markov model framework with four primary outcomes: (1) migraine days; (2) acute care drug treatment days; (3) number of physician and emergency room visits; and (4) workplace productivity.  We considered the impact of CGRP inhibitors on patients who are not currently on preventive therapy because existing non-CGRP inhibitor treatments are ineffective or intolerable for these patients.

Use of CGRP inhibitors was on average associated with fewer migraine days per year (-18.68/-29.20 for EM/CM), fewer triptan uses per year (-3.21/-5.04), more physician visits for migraine per year (1.03/1.02), fewer ER visits per year (-0.06/-0.10), higher probability of full-time (0.03/0.02) and part-time employment (0.01/0.00), fewer lost productive hours per year (-39.69/-21.31), and less indirect cost per year (-$20,327/-$11,176). Effects were generally greater for individuals with higher response to the drugs and varied by age and sex.

If all migraine sufferers not on preventive medicine used CGRP inhibitors, we estimate national indirect cost savings of $390 billion for EM and $6 billion for CM, as well as national reductions in migraine days per year of 358 million for EM and 16 million for CM.

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