Both atogepant and rimegepant for episodic migraine prevention far exceeded accepted cost-effectiveness thresholds, with ICERs over $450,000/QALY and $890,000/QALY respectively.
>$450,000/QALYatogepant's cost-effectiveness ratio — 3x above the accepted threshold
What the researchers found
Atogepant ICER: >$450,000/QALY; rimegepant ICER: >$890,000/QALY — both far exceeding the $150,000/QALY cost-effectiveness threshold. Drug acquisition cost was the dominant factor.
Why it matters
Despite proven efficacy, oral CGRP antagonists may face reimbursement and access challenges if their cost-effectiveness remains poor. This analysis highlights the need for price reductions or better patient selection to justify their use.
The numbers in context
Atogepant 60 mg and rimegepant 75 mg compared to placebo. 1-year time horizon. US societal perspective.
How the study worked
Decision tree model with 1-year time horizon from US societal perspective, simulating patient cohorts using trial-reported baseline and change-from-baseline monthly migraine days. Each drug compared to its own trial's placebo group.
Who was studied
US patients with episodic migraine
What this study cannot tell us
Each drug compared to its own trial's placebo (no direct comparison between drugs); 1-year horizon may not capture long-term benefits; indirect costs difficult to quantify precisely; societal perspective may differ from payer perspective; no comparison to injectable CGRP antibodies.
How to read the evidence
Moderate evidence from a well-constructed economic model using clinical trial data. Results are sensitive to drug pricing assumptions, which may change.
When this study was published
Published in 2024, reflecting current US drug pricing for oral CGRP antagonists approved in 2021.
The bigger picture
As CGRP-targeted therapies expand migraine treatment options, demonstrating value for money becomes critical for broad access. This study signals that current pricing models for oral CGRP antagonists may need revision for sustainable population-level adoption.
Questions still open
- What drug price reduction would bring oral CGRP antagonists below the $150,000/QALY threshold?
- How does the cost-effectiveness of oral CGRP antagonists compare to injectable CGRP antibodies?
- Would targeting oral CGRP antagonists to higher-frequency migraine patients improve their cost-effectiveness?
Common questions
Are the new oral migraine prevention pills worth the cost?
Could these drugs become cost-effective?
Read the original research
Cost-Effectiveness Evaluation of Oral CGRP Antagonists, Atogepant and Rimegepant, for the Preventative Treatment of Episodic Migraine: Results from a US Societal Perspective Model.
Clinical drug investigation, 44(3), 209-217
Citation
Thaliffdeen, Ryan; Yu, Anthony; Rascati, Karen. (2024). Cost-Effectiveness Evaluation of Oral CGRP Antagonists, Atogepant and Rimegepant, for the Preventative Treatment of Episodic Migraine: Results from a US Societal Perspective Model.. Clinical drug investigation, 44(3), 209-217. https://doi.org/10.1007/s40261-024-01345-3