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Objective <p>We aimed to evaluate the cost effectiveness of eptinezumab and erenumab as a preventive treatment of migraine in patients with episodic migraine with different routes of administration, from the US healthcare payer perspective.</p> Methods <p>A hybrid decision tree-Markov model was constructed to assess the cost effectiveness of eptinezumab and erenumab as a preventive treatment for migraines compared to topiramate among patients with episodic migraine from the US healthcare payer’s perspective. A decision tree model simulated the probability of patients experiencing adequate responses to treatments in the first 6 months, which fed into a Markov model using a 2-year time horizon. The Markov model consisted of three states: “Off Preventive Treatment,” “Preventive Treatment,” and death. Total costs, quality-adjusted life-years, and incremental cost-effectiveness ratios were estimated for each strategy followed by sensitivity analyses. An annual discount rate of 3% was applied to both costs and utility values, and costs were reported in 2025 US dollars.</p> Results <p>In the base-case results, total costs of eptinezumab and erenumab were $21,767 and $21,739, respectively. Total quality-adjusted life-years for eptinezumab and erenumab were 1.32 and 1.30, respectively. Base-case incremental cost-effectiveness ratios of eptinezumab and erenumab compared to topiramate were $117,626 and $155,259 per quality-adjusted life-year gained, respectively. Erenumab was eliminated because of extended dominance; thus, eptinezumab was selected for additional sensitivity analyses. In the one-way sensitivity analysis, treatment response, utility values, and drug costs were influential in changing the study’s conclusions. In the probabilistic sensitivity analysis, eptinezumab was cost effective in 1.8%, 33.6%, and 78.6% of simulations when the willingness-to-pay threshold was $50,000, $100,000, and $150,000 per quality-adjusted life-year gained, respectively.</p> Conclusions <p>Our analysis suggests that eptinezumab might be cost effective at a willingness-to-pay threshold of $150,000 per quality-adjusted life-year gained compared with topiramate, with uncertainties on health state utilities and pharmaceutical costs. Policymakers should carefully consider the tradeoffs between costs and benefits when making decisions regarding formulary coverage for the episodic migraine population.</p>

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Cost-Utility Analysis of Calcitonin Gene-Related Peptide Monoclonal Antibodies for Patients with Episodic Migraine Headache in the USA

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Ariel Weiming Dong,
  • Mark Bounthavong

摘要

Objective

We aimed to evaluate the cost effectiveness of eptinezumab and erenumab as a preventive treatment of migraine in patients with episodic migraine with different routes of administration, from the US healthcare payer perspective.

Methods

A hybrid decision tree-Markov model was constructed to assess the cost effectiveness of eptinezumab and erenumab as a preventive treatment for migraines compared to topiramate among patients with episodic migraine from the US healthcare payer’s perspective. A decision tree model simulated the probability of patients experiencing adequate responses to treatments in the first 6 months, which fed into a Markov model using a 2-year time horizon. The Markov model consisted of three states: “Off Preventive Treatment,” “Preventive Treatment,” and death. Total costs, quality-adjusted life-years, and incremental cost-effectiveness ratios were estimated for each strategy followed by sensitivity analyses. An annual discount rate of 3% was applied to both costs and utility values, and costs were reported in 2025 US dollars.

Results

In the base-case results, total costs of eptinezumab and erenumab were $21,767 and $21,739, respectively. Total quality-adjusted life-years for eptinezumab and erenumab were 1.32 and 1.30, respectively. Base-case incremental cost-effectiveness ratios of eptinezumab and erenumab compared to topiramate were $117,626 and $155,259 per quality-adjusted life-year gained, respectively. Erenumab was eliminated because of extended dominance; thus, eptinezumab was selected for additional sensitivity analyses. In the one-way sensitivity analysis, treatment response, utility values, and drug costs were influential in changing the study’s conclusions. In the probabilistic sensitivity analysis, eptinezumab was cost effective in 1.8%, 33.6%, and 78.6% of simulations when the willingness-to-pay threshold was $50,000, $100,000, and $150,000 per quality-adjusted life-year gained, respectively.

Conclusions

Our analysis suggests that eptinezumab might be cost effective at a willingness-to-pay threshold of $150,000 per quality-adjusted life-year gained compared with topiramate, with uncertainties on health state utilities and pharmaceutical costs. Policymakers should carefully consider the tradeoffs between costs and benefits when making decisions regarding formulary coverage for the episodic migraine population.