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Background <p>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.</p> Methods <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年7月15日

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

摘要

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.