Patient Preference and Adherence (Dec 2023)
Treatment Patterns, Healthcare Resource Utilization, and Direct Costs Among Patients Initiating Concomitant Use of a Calcitonin Gene-Related Peptide Monoclonal Antibody (CGRP mAb) and Novel Acute Medication in the United States
Abstract
Oralee J Varnado,1 Tania Gulati,2 Anthony Wheeler,3 Margaret Hoyt1 1Value Evidence Outcomes – Research & Neuroscience, Indianapolis, IN, USA; 2Value Evidence Outcomes, Real World Evidence, Eli Lilly Services India, Private Limited, Bengaluru, Karnataka, India; 3Value Evidence Outcomes – Outcomes Liaisons, Indianapolis, IN, USACorrespondence: Oralee J Varnado, Value Evidence Outcomes – Research & Neuroscience, Lilly Corporate Center, Indianapolis, IN, 46285, USA, Email [email protected]: To describe treatment patterns, all-cause and migraine-related healthcare resource utilization (HCRU), and direct costs among people with migraine treated with concomitant calcitonin gene-related peptide monoclonal antibody (CGRP mAb) and novel acute migraine medications (ubrogepant, rimegepant, lasmiditan) in the United States (US).Patients and Methods: This retrospective, observational cohort study utilized data from the IBM MarketScan® Research Databases and included adults initiating CGRP mAb or novel acute migraine medication as index medications between May 01, 2018, and Feb 28, 2021. All-cause and migraine-related HCRU (number of visits) and costs at baseline (12 months pre-index) and at follow-up (12 months post-index) were descriptively analyzed; differences between values at follow-up and baseline were reported.Results: Of 4,167 included in the analysis (mean [SD] age: 43.7 [11.2] years), 89.2% were women, and 59.7% had chronic migraine. Adherence to the indexed CGRP mAb was 47% (using proportion of days covered [PDC]) and 80.1% (using medication possession ratio [MPR]); mean (SD) persistence was 273.4 (115.3) days). At follow-up, 43.9% of the patients discontinued their index preventive medication of which 80.2% switched to a different preventive migraine medication; 17.0% restarted their index preventive medication. Reductions in all-cause inpatient HCRU, all-cause inpatient and outpatient costs, and migraine-related outpatient HCRU were observed at follow-up vs. baseline, whereas increases in all-cause outpatient HCRU, all-cause medication costs, migraine-related inpatient HCRU, and migraine-related inpatient, outpatient, and medication costs were observed.Conclusion: In this study, observed treatment patterns with the indexed CGRP mAb were consistent with prior reports. Concomitant treatment with CGRP mAb and novel acute migraine medications led to reductions in some outcomes of HCRU and direct costs, however, increases were also observed. Treatment utilization, reductions in HCRU and cost savings identified in this study in favor of concomitant CGRP mAb and novel acute medications may help clinicians and other healthcare decision makers assessing appropriate therapeutic options for migraine management.Plain Language Summary: What was known before?The American Headache Society recommends concomitant use of preventive and acute medications for migraine.Data on treatment outcomes, and healthcare resource utilization (HCRU) and medical costs are limited for patients with migraine who use preventive and acute migraine medications concomitantly.What does this study add?Patients with migraine started treatment with preventive medications – calcitonin gene-related peptide monoclonal antibodies [CGRP mAb] such as galcanezumab/fremanezumab followed by newer acute medications (ubrogepant, rimegepant, and lasmiditan).About half the patients who started their migraine treatment with CGRP mAb continued to use the same medication after 1-year on treatment.Of those patients who stopped their initial CGRP mAb medication, most switched to other preventive migraine medications such as antiepileptics and beta blockers.Patients taking CGRP mAb and newer acute migraine medications had fewer overall inpatient healthcare visits but a higher number of overall outpatient healthcare visits and lower overall inpatient and outpatient costs after 1-year of follow-up.InterpretationIncreases in healthcare costs for migraine treatment over a 1-year period were observed in patients who used CGRP mAb and newer acute migraine medications.At follow-up, greater cost savings were seen for non-migraine treatment utilization and some migraine-related healthcare utilization in concomitant CGRP mAb and newer acute medication users.This study may help healthcare providers and payors to better understand how patients who use acute and preventive treatments for migraine perform after one year of their initial treatment. This may inform them to make informed decisions on long-term treatment for patients with migraine.Keywords: migraine, CGRP mAb, adherence, persistence, cost savings
