In Ireland's managed access program for treatment-refractory chronic migraine, 96% of CGRP antibody applications were approved, ~90% of patients were adherent, and over 75% persisted beyond 12 months, with €3.2 million spent in the first year.
>75% persisted >12 monthsCGRP antibody treatment persistence in Ireland's managed access program for treatment-refractory chronic migraine
What the researchers found
96.1% approval rate for CGRP mAb applications. ~90% adherence rate. >75% persistence beyond 12 months. €3.2 million first-year expenditure under managed access in Ireland.
Why it matters
Demonstrating that managed access can successfully balance patient access with cost containment gives other healthcare systems a model for introducing expensive peptide-based therapies. The high adherence and persistence rates also suggest these drugs are genuinely benefiting patients.
The numbers in context
Patients must have failed 3 or more previous treatments to qualify. Data extracted from national pharmacy claims databases.
How the study worked
Analysis of claims data from Ireland's Primary Care Reimbursement Service High Tech database and drug request system (September 2021 - April 2023). Evaluated persistence via refill patterns and adherence via proportion of days covered.
Who was studied
Treatment-refractory chronic migraine patients in Ireland
What this study cannot tell us
Single-country study (Ireland). No clinical outcome data (headache days, quality of life) — only utilization metrics. The managed access criteria (3+ prior treatment failures) create a selected population. No comparison to outcomes without managed access restrictions.
How to read the evidence
Moderate evidence from national claims database analysis. Robust utilization data but no clinical outcome measures.
When this study was published
Published in 2024, covering data from 2021-2023. Reflects early real-world experience with managed CGRP antibody access.
The bigger picture
As biologic and peptide-based therapies become more common across medicine, healthcare systems worldwide face the challenge of providing access to expensive treatments while managing budgets. Ireland's CGRP managed access model provides real-world evidence that this balance is achievable.
Questions still open
- Would clinical outcomes be better if CGRP antibodies were available earlier in the treatment pathway?
- How does Ireland's managed access experience compare to other countries' approaches?
- What drives the ~10% non-adherence — side effects, cost, or other factors?
Common questions
Why do patients need to fail 3 treatments before getting CGRP antibodies in Ireland?
Does high persistence mean the drugs are working?
Read the original research
Utilization, Expenditure, and Treatment Patterns Associated With Calcitonin Gene-Related Peptide Monoclonal Antibodies Reimbursed Subject to a Managed Access Protocol in Ireland.
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 27(8), 1039-1045
Citation
Smith, Amelia; Finnigan, Karen; Clarke, Sarah; Barry, Michael; Gorry, Claire. (2024). Utilization, Expenditure, and Treatment Patterns Associated With Calcitonin Gene-Related Peptide Monoclonal Antibodies Reimbursed Subject to a Managed Access Protocol in Ireland.. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 27(8), 1039-1045. https://doi.org/10.1016/j.jval.2024.04.002