CGRP Antibodies in Ireland: High Adherence and Cost Management Under a Managed Access Program for Refractory Migraine
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.
Quick Facts
What This Study 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.
Key Numbers
Patients must have failed 3 or more previous treatments to qualify. Data extracted from national pharmacy claims databases.
How They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- >75% persisted >12 months CGRP antibody treatment persistence in Ireland's managed access program for treatment-refractory chronic migraine
- Evidence Grade:
- Moderate evidence from national claims database analysis. Robust utilization data but no clinical outcome measures.
- Study Age:
- Published in 2024, covering data from 2021-2023. Reflects early real-world experience with managed CGRP antibody access.
- Original Title:
- Utilization, Expenditure, and Treatment Patterns Associated With Calcitonin Gene-Related Peptide Monoclonal Antibodies Reimbursed Subject to a Managed Access Protocol in Ireland.
- Published In:
- Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 27(8), 1039-1045 (2024)
- Authors:
- Smith, Amelia(2), Finnigan, Karen, Clarke, Sarah, Barry, Michael, Gorry, Claire
- Database ID:
- RPEP-09289
Evidence Hierarchy
Frequently Asked Questions
Why do patients need to fail 3 treatments before getting CGRP antibodies in Ireland?
CGRP antibodies are expensive, so Ireland requires patients to have tried and failed at least 3 cheaper preventive treatments first. This ensures the drugs go to patients who truly need them and helps manage healthcare budgets.
Does high persistence mean the drugs are working?
High persistence (>75% continuing beyond 12 months) is a positive signal that patients are benefiting, since people tend to stop medications that aren't helping. However, this study didn't directly measure migraine outcomes — formal clinical assessments would confirm effectiveness.
Read More on RethinkPeptides
Cite This Study
https://rethinkpeptides.com/research/RPEP-09289APA
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
MLA
Smith, Amelia, et al. "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, 2024. https://doi.org/10.1016/j.jval.2024.04.002
RethinkPeptides
RethinkPeptides Research Database. "Utilization, Expenditure, and Treatment Patterns Associated ..." RPEP-09289. Retrieved from https://rethinkpeptides.com/research/smith-2024-utilization-expenditure-and-treatment
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkPeptides research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.