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 Vol. 27; no. 8; pp. 1039 - 1045
• Main Authors: Smith, Amelia, Finnigan, Karen, Clarke, Sarah, Barry, Michael, Gorry, Claire
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2024
• Subjects: Adult; Antibodies, Monoclonal - economics; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - economics; Antibodies, Monoclonal, Humanized - therapeutic use; Calcitonin Gene-Related Peptide; CGRP mAbs; chronic migraine; Drug Costs; Female; Health Expenditures; health technology management; Humans; Internal Medicine; Ireland; Male; Medication Adherence; Middle Aged; Migraine Disorders - drug therapy; Migraine Disorders - economics; Public Health; Ireland; chronic migraine; health technology management; CGRP mAbs
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2024.04.002

Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are novel high-cost treatments for the prevention of migraine. This study presents data on utilization, expenditure, and treatment patterns with CGRP mAbs available under a managed access protocol in Ireland, to a cohort of treatment refractory patients (failed 3 or more previous treatments) with chronic migraine. Data were extracted from the Primary Care Reimbursement Service High Tech claims database and special drug request online system and analyzed using Microsoft Excel and SAS. Treatment persistence was evaluated by refill patterns, and adherence was evaluated using the proportion of days covered method. Expenditure data were extracted directly from the database. Between September 1, 2021 and April 30, 2023, 1517 applications for reimbursement approval for a CGRP mAb were received; 1458 (96.1%) were approved for reimbursement. Total expenditure on CGRP mAbs in year 1 (September 1, 2021 to August 31, 2022) was €3.2 million. The majority of patients initiated treatment with fremanezumab (60.8%) or erenumab (37.1%). Almost 90% of patients were considered adherent, and treatment persistence was high, with more than 75% of patients receiving more than 12 months of treatment in our 18-month study time frame. This study demonstrates the importance of active health technology management, after reimbursement, in enabling cost-effective use of high-cost treatments while providing budget certainty for the healthcare payer. High levels of adherence and persistence suggest that treatment is successfully targeted in situations which unmet clinical need is greatest. •Calcitonin gene-related peptide monoclonal antibodies are novel, high-cost treatments for the prevention of migraine.•In 1 year of reimbursement in Ireland, the total expenditure on calcitonin gene-related peptide was €3.2 million, with the majority of approved patients being highly treatment adherent.•Health technology management can ensure cost containment while maintaining access to treatment in situations which unmet clinical need is greatest.