BACKGROUND: Frequent migraine with four or more headache days per month is a 
common, disabling neurovascular disease. From a US societal perspective, this 
analysis models the clinical efficacy and estimates the value-based price (VBP) 
for erenumab, a fully human monoclonal antibody that inhibits the calcitonin 
gene-related peptide receptor.
METHODS: A Markov health state transition model was developed to estimate the 
incremental costs, quality-adjusted life-years (QALYs), and value-based price 
range for erenumab in migraine prevention. The model comprises "on preventive 
treatment", "off preventive treatment", and "death" health states across a 
10-year time horizon. The evaluation compared erenumab to no preventive 
treatment in episodic and chronic migraine patients that have failed at least 
one preventive therapy. Therapeutic benefits are based on estimated changes in 
monthly migraine days (MMD) from erenumab pivotal clinical trials and a network 
meta-analysis of migraine studies. Utilities were estimated using previously 
published mapping algorithms. A VBP analysis was performed to identify maximum 
erenumab annual prices at willingness-to-pay (WTP) thresholds of 
$100,000-$200,000 per QALY. Estimates of VBP under different scenarios such as 
choice of different comparators, assumptions around inclusion of placebo effect, 
and exclusion of work productivity losses were also generated.
RESULTS: Erenumab resulted in incremental QALYs of 0.185 vs supportive care (SC) 
and estimated cost offsets due to reduced MMD of $8,482 over 10 years, with an 
average duration of treatment of 2.01 years. The estimated VBP at WTP thresholds 
of $100,000-$200,000 for erenumab compared to SC ranged from $14,238-$23,998. 
VBP estimates including the placebo effect and excluding work productivity 
ranged from $7,445-$13,809; increasing to $12,151-$18,589 with 
onabotulinumtoxinA as a comparator in chronic migraine.
CONCLUSION: Erenumab is predicted to reduce migraine-related direct and indirect 
costs, and increase QALYs compared to SC.