Cost-effectiveness analysis of ubrogepant, rimegepant, and zavegepant for acute migraine treatment vs usual care
Abstract
OBJECTIVE: Migraine is a debilitating chronic disorder requiring multifaceted treatment approaches, including acute, preventive, and nonpharmacological interventions. Small-molecule calcitonin gene-related peptide (CGRP) receptor antagonists, also referred to as gepants , provide third-line treatment options for patients refractory to first- and second-line therapies. This study evaluates the cost-effectiveness of 3 CGRP antagonists-ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), and zavegepant (Zavzpret)-compared with usual care.
STUDY DESIGN: Cost-effectiveness analysis of gepants vs usual care.
METHODS: We used a Markov model to assess the cost-effectiveness from the US payer's perspective, incorporating 5 health states: mild, moderate, and severe pain while on treatment; no pain while on treatment; and off treatment. The analysis was conducted over a 5-year time horizon with a 48-hour cycle length, discounting costs and quality-adjusted life-years (QALYs) annually at 3%. Scenario analyses were used to determine the robustness of the results.
RESULTS: None of the gepants were cost-effective at willingness-to-pay thresholds of $50,000, $100,000, or $150,000 per QALY. Among the 3 gepants, rimegepant was the most cost-effective option; it had an incremental cost-effectiveness ratio of $93,700.20 per QALY compared with ubrogepant and was both less costly and more effective than zavegepant.
CONCLUSIONS: Ubrogepant, rimegepant, and zavegepant are not cost-effective options for…
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