May 30, 2024

Summary of Research Showing Cost-Benefit of Analysis of Anti-CGRP monoclonal antibodies

Though CGRP monoclonal antibodies (MAbs) have become well established in the past years, in many countries, these drugs are only prescribed as a last resort because of their perceived high-cost. For example, in Spain, CGRP MAbs can be prescribed for chronic migraine only after three or more preventive treatments, including onabotulinumtoxinA, are tried and failed. 

In their recent paper, Early and annual projected savings from anti-CGRP monoclonal antibodies in migraine prevention: a cost-benefit analysis, researchers in Spain tracked patients using CGRP MAbs to determine the cost-benefit of these medications in the working age population. 


Before and throughout the study, participants completed detailed e-diaries which included reports of their migraine and headache days, acute medication days, and any other treatment such as Emergency Room (ER) visits. Patients had follow up every 3 months. The work productivity and activity impairment questionnaire (WPAI) was used to assess employment status and was given to patients at each follow-up visit.

The researchers were able to calculate the cost savings associated with the use of CGRP MAbs. ​ They found that the savings from reduced absenteeism and presenteeism outweighed the costs of the medication, resulting in a positive cost-benefit balance. ​ The savings were calculated per patient and projected for a year of treatment. ​


The researchers compared costs at baseline (M0),  after 3 months and after 6 months of  treatment, to determine a cost-benefit analysis of the direct and indirect costs. Direct costs included those attributed to the CGRP MAbs, consultations, ER visits and acute medications. Indirect costs included work time loss (absenteeism) and work impairment (presenteeism). ​ 

They found that using CGRP MAbs reduced absenteeism and presenteeism and had a positive impact as early as the first three months of treatment. They found a savings of just over €1600 (about $1735) per patient per month. After 6 months, savings increased for patients who continued CGRP MAbs. 

Researchers also found that treatment was able to compensate for the cost of a non-responders. Usually, if someone is a “responder” to a migraine medicine, this means they have an improvement of about 50% of their migraine attacks. Due to the findings seen, the researchers recommended lowering the threshold of response from 50% to 30%. 

Policy and Clinical Implications

This study suggests that CGRP MAbs are cost-effective. In light of the new data on the cost-effectiveness of CGRP MAbs, national reimbursement policies may need to be updated, especially the policies requiring step therapy of several older non-migraine-specific medications before covering CGRP Mabs. 

Researchers hope that it will lead to a reduction in such policies in Spain and elsewhere. With broader research and the support of advocates they are hopeful that the criteria for prescribing CGRP MAbs will be reassessed which will help patients get more specific treatment earlier. 

Listen to Dr. Edoardo Caronna discuss his research.  


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