{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:28:16Z","timestamp":1785338896434,"version":"3.55.0"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T00:00:00Z","timestamp":1701734400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T00:00:00Z","timestamp":1701734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Institute for Health Research (NIHR) Health Technology Assessment programme","award":["NIHR132803"],"award-info":[{"award-number":["NIHR132803"]}]},{"name":"National Institute for Health Research (NIHR) Health Technology Assessment programme","award":["NIHR132803"],"award-info":[{"award-number":["NIHR132803"]}]},{"name":"National Institute for Health Research (NIHR) Health Technology Assessment programme","award":["NIHR132803"],"award-info":[{"award-number":["NIHR132803"]}]},{"name":"National Institute for Health Research (NIHR) Health Technology Assessment programme","award":["NIHR132803"],"award-info":[{"award-number":["NIHR132803"]}]},{"name":"National Institute for Health Research (NIHR) Health Technology Assessment programme","award":["NIHR132803"],"award-info":[{"award-number":["NIHR132803"]}]},{"name":"National Institute for Health Research (NIHR) Health Technology Assessment programme","award":["NIHR132803"],"award-info":[{"award-number":["NIHR132803"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Headache Pain"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Migraine is the world\u2019s second most common disabling disorder, affecting 15% of UK adults and costing the UK over \u00a31.5 billion per year. Several costly new drugs have been approved by National Institute for Health and Care Excellence.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Aim<\/jats:title>\n                <jats:p>To assess the cost-effectiveness of drugs used to treat adults with chronic migraine.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We did a systematic review of placebo-controlled trials of preventive drugs for chronic migraine. We then assessed the cost-effectiveness of the currently prescribable drugs included in the review: Onabotulinum toxin A (BTA), Eptinezumab (100mg or 300mg), Fremanezumab (monthly or quarterly dose), Galcanezumab or Topiramate, each compared to placebo, and we evaluated them jointly. We developed a Markov (state-transition) model with a three-month cycle length to estimate the costs and quality-adjusted life years (QALYs) for the different medications from a UK NHS and Personal Social Services perspective. We used a two-year time horizon with a starting age of 30 years for the patient cohort. We estimated transition probabilities based on monthly headache days using a network meta-analysis (NMA) developed by us, and from published literature. We obtained costs from published sources and applied discount rates of 3.5% to both costs and outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Deterministic results suggest Topiramate was the least costly option and generated slightly more QALYs than the placebo, whereas Eptinezumab 300mg was the more costly option and generated the most QALYs. After excluding dominated options, the incremental cost-effectiveness ratio (ICER) between BTA and Topiramate was \u00a368,000 per QALY gained and the ICER between Eptinezumab 300mg and BTA was not within plausible cost-effectiveness thresholds. The cost-effectiveness acceptability frontier showed that Topiramate is the most cost-effective medication for any amount the decision maker is willing-to-pay per QALY.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Among the various prophylactic medications for managing chronic migraine, only Topiramate was within typical cost-effectiveness threshold ranges. Further research is needed, ideally an economic evaluation alongside a randomised trial, to compare these newer, expensive CGRP MAbs with the cheaper oral medications.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s10194-023-01686-y","type":"journal-article","created":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T10:01:54Z","timestamp":1701770514000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Competing treatments for migraine: a headache for decision-makers"],"prefix":"10.1186","volume":"24","author":[{"given":"Hema","family":"Mistry","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyran","family":"Naghdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Underwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callum","family":"Duncan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Madan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjit","family":"Matharu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,12,5]]},"reference":[{"issue":"1","key":"1686_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s10194-020-01208-0","volume":"21","author":"T Steiner","year":"2020","unstructured":"Steiner T, Stovner L, Jensen R, Uluduz D, Katsarava Z (2020) Migraine remains second among the world\u2019s causes of disability, and first among young women: findings from GBD2019. 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He is a director and shareholder of Clinvivo Ltd that provides electronic data collection for health services research. He is part of an academic partnership with Serco Ltd, funded by the European Social Fund, related to return to work initiatives. He is a co-investigator on two current and one completed NIHR funded studies that have, or have had, additional support from Stryker Ltd. CD is chair of Scottish Intercollegiate Guideline Network (SIGN) 155 and has provided advise on the use of BTA, CGRP MAbs and CGRP antagonists to the Scottish Medicines Consortium and on Eptinezumab to NICE. He is the Secretary for the British Association for the Study of Headache 2015-2022 and he is a Board member of Anglo Dutch Migraine Association. MM is the President of the medical advisory board of the CSF Leak Association. He has received consulting fees from AbbVie, TEVA, Lundbeck, Eli Lilly, Salvia, Pfizer. He has received payment for the development of educational presentations from AbbVie, Pfizer and Eli Lilly and support for attending a meeting from Pfizer. He has is on the advisory board for AbbVie, TEVA, Lunbeck, Eli Lilly, Salvia and Pfizer. He has the following patent issued WO2018051103A1: System and method for diagnosing and treating headaches. He has stock options with Tesla, Adobe, Nvidia, META and Microsoft. He has received grants from Abbott, Medtronic and Ehlers Danlos society.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"162"}}