Director of Product Strategy for Clinical Trial Solutions
Evernorth Health Services United States
Objectives
This study analyzed real-world evidence to determine the quantity of medication and cost associated with treatment for acute attacks in patients taking calcitonin gene receptor peptide (CGRP) antibodies (“CGRP cohort”) compared to a control group not taking CGRP preventive medication.
Method
Patients filing CGRP antibodies from the Express Scripts de-identified pharmacy claims database comprised the CGRP cohort. A randomized matched control cohort of patients not filling CGRP antibodies was identified based on acute and preventive migraine therapy.
Results
This retrospective cohort study included 4,229 continuously eligible patients in each cohort (CGRP mean age 47 years, 89% female; control mean age 49 years, 86% female). For inclusion, patients in the CGRP cohort were required to fill prescriptions for acute migraine treatment during the three months prior to filling a CGRP antibody. The six-month study period varied for each patient in the CGRP cohort based on the date of their first CGRP antibody claim whereas the control cohort timeframe was fixed based on the May 25, 2018 date when the first CGRP claim was filled. Control cohort patients were matched to the CGRP cohort according to the number of preventive migraine medications and quantity and cost of acute migraine medications utilized during the three-month period prior to CGRP antibodies entering the market. During the three months prior to CGRP blockers, patients in both cohorts filled an average quantity of 28 units of acute migraine medication per patient with an associated cost of $442.49 per patient in the CGRP cohort versus $426.85 in the control cohort (p = NS). Patients in the CGRP cohort were followed three months forward from their first claim of a CGRP antibody in an intent-to-treat fashion and filled an average quantity of 16 units of acute migraine medication per patient while those in the control cohort filled an average of 20 units per patient (p = 0.0001). The associated cost for acute medication was $255.86 per patient in the CGRP cohort and $297.35 per patient in the control cohort (p = 0.0093). The average cost per patient for all migraine therapy (acute plus preventive) in the three months preceding entry of CGRP antibodies to the marketplace was $728.02 for the CGRP cohort versus $605.75 in the control cohort (p = 0.0001). After the introduction of CGRP antibodies, the overall cost increased to $1,806.43 for the CGRP cohort while the control cohort dropped to $468.60 during the same period.
Conclusion
This study provides early real-world evidence on the usage of migraine prophylaxis with CGRP blocking medications and specifically studied the effects on use of acute migraine treatment. Although addition of a CGRP antibody resulted in an overall increase in cost for migraine management, a statistically significant reduction in the cost and quantity of acute medications was observed. A decreased quantity of acute medication filled by patients may translate to a decreased number of acute migraines treated and benefit to patients. In general, acute medications, such as the serotonin receptor agonists (“triptans”), are dosed as “one unit at onset of migraine, may repeat one time”. Therefore, two units are roughly equivalent to one migraine. The results of this study support the randomized clinical trials for CGRP antibodies that demonstrated a reduction of one to two migraines per month when compared to placebo.
