Policy and patient advocacy groups are calling on the Institute for Clinical and Economic Review to rerun its analysis on the cost-effectiveness of three drugs to treat acute migraines, using ICER’s updated framework that considers societal factors. The advocacy groups expect the cost-effectiveness rating of the three drugs would increase further using that framework.
The value review board previously said in November that older migraine drugs are more cost-effective than the three new brand medications.
But patient advocacy groups say the latest report still under-values the benefits of these new medicines because it does not account for the societal and physical costs of migraines. The analysis is one of the last that the review board is conducting under its original analytic framework, which does not take into account a modified societal perspective within its case analysis. The groups say ICER should re-evaluate the drugs using the new framework because migraine disease has a large societal impact due to missed work and depression.
“We call on ICER to re-run the analysis on these three acute treatments for migraine attacks using the new framework with a greater inclusion of societal factors. We believe this will improve the cost-effectiveness rating for all three medicines and should move the Rainbow (lasmiditan) rating to within their cost-effectiveness threshold,” the Coalition for Headache and Migraine Patients and the Headache and Migraine Policy forum said in a joint statement.
Many migraine treatments are decades old, and the review board's final report compared older data to modern technologies.
“We think that’s an inappropriate approach,” Lindsay Videnieks, executive director of the Headache and Migraine Policy Forum, said.
Vidernieks also opposes the report’s failure to fully consider the impact of migraine disease on the opioid epidemic; migraine patients are often initially treated with opioids, which can lead to addiction.
The ICER report notes that the use of opioids to treat migraines is driven by a lack of existing therapies.
Suicide prevalence is much higher among migraine sufferers than in the general community, and the report does not take this into account either, according to Value Our Health, a group of organizations representing patients with disabilities. By eliminating mortality effects from its study, the group says that ICER fails to capture the full implications of migraines.