Economic Evaluation of Treatments for Migraine: An Assessment of the Generalizability Following a Systematic Review

DOI: https://doi.org/10.1007/s40273- 019- 00879- 1

Abstract-Summary The aim of this study was to review the economic evaluations on the prophylaxis and treatments for migraine published in the previous 10 years (since 2009) and to perform a critical assessment of their generalizability.

To assess the level of generalizability, we used the checklist implemented by Augustovski and others Studies were classified as: (1) generalizable; (2) transfer- able; and (3) context specific.

227 articles were identified after running the search string and 11 studies were

included in our review.

None of the studies was judged as generalizable and three were judged transfer-

able according to the established criteria.

Our review suggests that no evidence on the economic value of either acute or prophylactic treatments against migraine is generalizable to different jurisdictions. The majority of studies reporting results about prophylactic treatments were

found to be transferable.

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Extended: The aim of this study was to review the economic evaluations on the prophylaxis and treatments for EM and CM to assess the level of generalizability of single studies, as an important and transparent support to the decision-making process.

The aim of our study was to assess the generalizability of economic evidence by

means of a validated and widely used checklist [337–339].

To assess the level of generalizability of the articles included in this review, the

checklist implemented by Augustovski and others [338, 340] was used.

227 articles were identified after running the search string on the selected

databases.

Our review suggests that studies assessing the cost effectiveness of prophylactic treatments are more likely to be a useful support for decision makers as three of them were judged transferable [341–343].

Introduction Healthcare and societal costs associated with migraine amount to US$36 billion per year in the USA.

The evidence arising from the health economic evaluations (HEEs) of the avail- able strategies for the treatment of migraine has been pooled in four systematic reviews of the literature.

Two reviews [344, 345] investigated the cost effectiveness of oral serotonin

receptor agonists for the treatment of CM.

A third review [346] was published in 2009 and underlined the methodological challenges arising from the cost-effectiveness analyses conducted on the pharmaco- therapies for migraine.

In the last review, [347] conducted in 2012, the focus was on the cost effective-

ness of acupuncture in chronic pain, including migraine.

The heterogeneity of different strategies, previously underlined in other reviews, has substantially increased and, perhaps, any attempt to compare the cost effective- ness across different studies is too ambitious.

Methods During either the selection or the review process, discrepancies between the review- ers were addressed by giving priority to the opinion of the scholar with the most coherent background depending on the type of issue (i.e., concerning discrepancies regarding study design, priority was given to the statistician’s opinion).

The selected items were:the clear description of the study setting and the alterna- tives being compared;the multicentric study design (only for randomized controlled trial-based HEEs);the clinical and cost data referring to the whole study population;the preference data relevant to the study population;the presence of quantitative/qualitative analysis performed to appraise the variability of results from setting to setting;the adoption of a wide study perspective (healthcare payer or societal);a clear justification of the model structure and parameters (only for model- based HEEs);the presence of a stochastic analysis to explore uncertainty (only for model-based HEEs);full reporting of baseline characteristics of the study sample;the

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reporting of the epidemiology (if relevant);the reporting source of utility data;a separate reporting of unitary costs and resource consumption amounts.

Results All studies [341–343, 348–355] reported an ICER, which in seven articles was expressed in terms of cost per QALY.

Each study included in this review considered both clinical and cost data refer-

ring to the study population.

Of Slof, [352] (dis)utilities from the Health Utility Index 3 were attributed to

patients enrolled in a clinical trial based on their severity.

The migraine populations considered in the study of Lipton and others [351] were 50% CM and 50% EM, plus sub-groups of patients who had previously not responded to prior preventative therapy.

The study of Slof [352] associated severity-related (dis)utilities to patients

according to clinical trial results by using the Health Utility Index 3.

The study of Hens and others [348] only reported the costs of a single dose of the

triptans included in the model.

Discussion The study of Asseburg and others [356] evaluates different strategies for acute migraine by using a network meta-analysis, whilst Augustovski and others [338] only provide methodological requirements to assess the generalizability of trial- and model-based economic evaluations.

This choice could be seen as a limit of the study, on the other hand, our choice was based on focusing our analysis more on the quality and generalizability, to pro- vide suitable information for decision makers.

Our main goal was to provide decision makers and researchers with the current developments in the methodological quality of the economic studies in the field of migraine.

The quality of the included articles was good, although none of the studies was

judged as generalizable according to the established criteria.

Our review suggests that studies assessing the cost effectiveness of prophylactic treatments are more likely to be a useful support for decision makers as three of them were judged transferable [341–343].

Conclusions Our review found that no studies reporting evidence on the economic value of either acute or prophylactic treatments for migraine were generalizable to different jurisdictions.

All the studies that were judged as transferable reported results about prophylac- tic treatments and therefore were likely to have a higher chance of efficiently sup- porting decision makers of other jurisdictions.

Acknowledgement A machine generated summary based on the work of Ruggeri, Matteo; Drago, Carlo; Rosiello, Francesco; Orlando, Valentina; Santori, Costanza. 2020  in PharmacoEconomics.

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