Impact of a reimbursement policy change on treatment with erenumab in migraine – a real-world experience from Germany

The Journal of Headache and Pain

Research

Lucas Hendrik Overeem¹  Mira Fitzek¹  Kristin Sophie Lange¹  Paul Triller¹  Ja Bin Hong¹  Anke Siebert¹  Bianca Raffaelli²  Uwe Reuter³ 

[1] Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany;Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany;Clinician Scientist Program, Berlin Institute of Health (BIH) at Charité, Berlin, Germany;Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany;Universitätsmedizin Greifswald, Greifswald, Germany;

关键词: Migraine;    Preventive treatment;    Monoclonal antibodies;    Calcitonin gene-related peptide;    Erenumab;    Insurance coverage;    Health policy;   

DOI  :  10.1186/s10194-023-01682-2

 received in 2023-09-25, accepted in 2023-10-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMonoclonal antibodies (mAbs) targeting the Calcitonin Gene-Related Peptide (CGRP) pathway are safe and effective treatments for migraine prevention. However, the high cost of these novel therapies has led to reimbursement policies requiring patients to try multiple traditional preventives before access. In Germany, a recent change in insurance policy significantly expanded coverage for the CGRP receptor mAb erenumab, enabling migraine patients who failed just one prior prophylactic medication to receive this mAb. Here, we compare the clinical response to treatment with erenumab in migraine patients treated using the old and new coverage policy.MethodsIn this retrospective cohort study, we included CGRP-mAb naïve patients with episodic or chronic migraine, who started erenumab at our headache center according to either the old or the new insurance policy and received at least 3 consecutive injections. Headache diaries and electronic documentation were used to evaluate reductions in monthly headache and migraine days (MHD and MMD) and ≥ 50% and ≥ 30% responder rates at month 3 (weeks 9–12) of treatment.ResultsWe included 146 patients who received erenumab according to the old policy and 63 patients that were treated using the new policy. At weeks 9–12 of treatment, 37.7% of the old policy group had a 50% or greater reduction in MHD, compared to 63.5% of the new policy group (P < 0.001). Mean reduction in MHD was 5.02 days (SD = 5.46) and 6.67 days (SD = 5.32, P = 0.045) in the old and new policy cohort, respectively. After propensity score matching, the marginal effect of the new policy on treatment outcome was 2.29 days (standard error, SE: 0.715, P = 0.001) more reduction in MHD, and 30.1% (SE: 10.6%, P = 0.005) increase in ≥ 50% response rate for MHD.ConclusionsStarting erenumab earlier in the course of migraine progression in a real-world setting may lead to a better response than starting after multiple failed prophylactic attempts. Continually gathering real-world evidence may help policymakers in deciding how readily to cover CGRP-targeted therapies in migraine prevention.

【 授权许可】

CC BY   
© The Author(s) 2023

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