Objectives
A cost-effectiveness model (CEM) for fremanezumab in migraine prevention from a Japanese public healthcare payer perspective has been developed. To inform health state specific utilities, we analyzed the correlation between the number of monthly migraine days (MMD) and a patient’s quality-of-life using data from Japanese-Korean trials.
Methods
The health states in the CEM are defined by the number of MMD, ranging from 0 to 28. Data from three Japanese-Korean clinical trials (406-102-00001, 406-102-00002, 406-102-00003) was analyzed. MSQoL (migraine specific quality of life) values measured in the trials were mapped to EQ-5D-3L utility values using a previously published mapping algorithm. To account for the repeated nature of the data, linear mixed effects models were fitted to the EQ-5D-3L values. MMD, MMD at baseline, treatment arm (monthly injection, quarterly injection, placebo), scheduled visits (month 1, month 2 etc.), age, sex, prior migraine medication and country were explored as covariates. The final model was selected based on the Akaike information criterion (AIC) value using forward and backward selection.
Results
In total, 3743 utility values from 970 patients were included in our analyses. The mean observed utility value was 0.83 for patients with 0 MMD and 0.51 for patients with 28 MMD. Fremanezumab decreased the number of MMD, thereby increasing a patient’s quality-of-life. The variables MMD, baseline MMD, scheduled visits and country were included in the final model. The regression coefficient for MMD was -0.01 (p<0.001), demonstrating that, after adjusting for baseline MMD, schedule visits and country, utility decreased by 0.01 for every day increase in MMD.
Conclusions
There was a strong correlation between the number of MMD and quality-of-life in patients with migraine. Estimates derived from the linear mixed-effects model can be used to inform health-state specific utilities in the Japanese cost-effectiveness model for fremanezumab in migraine prevention.
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