Migraine Characteristics, Comorbidities, Healthcare Resource Utilization, and Associated Costs of Early Users of Erenumab in the USA: A Retrospective Cohort Study Using Administrative Claims Data

DOI: https://doi.org/10.1007/s40122- 021- 00319- z

Abstract-Summary The objective of this study was to provide descriptive information on real-world use of erenumab including patient profile and treatment patterns.

We completed a retrospective review of US data (through May 2019) from the IBM MarketScan® Early View Databases, identifying adult patients newly treated with erenumab with a migraine claim in the year prior to first erenumab claim (index) and at least 1 year of continuous pre-index medical and pharmacy insurance coverage, to assess pre- and post-erenumab migraine characteristics, comorbidities, healthcare resource utilization, and associated costs.

The average (SD) age was 46 (12) years, 85% of patients were female, and 64% had at least one claim for chronic migraine; 70% of erenumab users had an initial

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dose of 70  mg; 77% of patients in the 6-month follow-up sample (n  =  4437) remained on their initial erenumab dose.

In the post-erenumab period, claims for comorbidities of non-migraine head- aches and anxiety were reduced and there was a shift to decreased use of acute and preventive medications.

Reductions in overall use and associated cost of healthcare resources such as inpatient hospitalization and outpatient office visits were minimal, with slightly more pronounced reductions in the subgroup of patients that were persistent to erenumab.

We observed reductions in claims for important migraine characteristics, comor- bidities, and a shift to decreased use of acute and preventive migraine medica- tions—observations indicative of the real-world effectiveness of erenumab.

Extended: We completed a sensitivity analysis excluding patients prescribed non-erenumab CGRP pathway antagonists from the analysis and noted similar pat- terns of change as the primary analysis for both acute and preventive medications.

We completed a retrospective, claims-based analysis designed to understand the real-world impact of erenumab as a migraine preventive including changes in migraine characteristics, comorbidities, healthcare resource utilization, and associ- ated costs.

The average (SD) age at first erenumab claim for the full study population was

46.5 (12.1) years and 85.4% of users were women.

Introduction A recent retrospective analysis of claims for 8707 patients showed persistence of 25% after the first 6 months of treatment declining to 14% by 12 months, for the 14 most common medications used for migraine prevention [451].

These low rates of persistence may lead to increased burden of migraine as healthcare resource utilization has been shown to be greater among individuals who failed multiple migraine preventive therapies [452].

More effective and tolerable preventive treatments may promote wider use with

the potential to reduce the burden of migraine to individuals and society.

Erenumab (erenumab-aooe in the USA) was approved in the USA by the Food and Drug Administration (FDA) on 17 May 2018 for the preventive treatment of migraine in adults.

We conducted a claims-based, retrospective observational study to examine the impact of erenumab treatment as a migraine preventive on migraine characteristics, comorbidities, healthcare resource utilization, and associated costs.

Methods In a sample of patients with 6-month follow-up data, pre- and post-erenumab migraine characteristics, comorbidities, treatment characteristics, healthcare resource utilization, and associated costs in US dollars ($) were described 6 months pre- and post-index.

Healthcare utilization was measured as prescription of medications used for the acute and preventive treatment of migraine, emergency room visits (service place code 23), outpatients care (service place code 22 [outpatient hospital] or 11 [office]),

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in-patient hospitalizations (service code 21) and inpatient length of hospital stay, brain imaging studies (Current Procedural Terminology [CPT] code or HCPCS code for an imaging procedure [e.g., CT Head 70,450–70,492, MRI Head 70,336, 76,390, 70,540–70,559] containing HCPCS modifier code 26 to avoid double count- ing) and their associated costs for 6  months prior to and 6  months after the first claim of erenumab.

Results In the post-index period, reductions in costs were slightly higher for persistent patients (− $218, $1245 post versus $1463 pre) than non-persistent patients (− $105, $916 post versus $1021 pre).

With these changes, the average costs for preventive medication decreased slightly between pre- and post-erenumab periods with slightly higher reductions for persistent than non-persistent patients; − $226 ($1120 post versus $1346 pre) for persistent patients and  −  $176 ($1127 post versus $1303 pre) for non-persistent patients.

Aligned to overall reductions in the use of acute and preventive medications in the pre-index period, total costs for acute and preventive medications were reduced with slightly higher reductions in costs for persistent (− $444, $2365 post versus $2809 pre) versus non-persistent (− $281, $2043 post versus $2324 pre) patients. Discussion A preliminary review of changes in acute migraine-specific medications pre- and post-erenumab initiation using pharmacy data also observed reductions in acute medication use post-erenumab [453].

Using a combined electronic health record and claims database, Tepper and col- leagues [454] observed significant reductions in migraine-specific acute medication use and healthcare resource utilization.

Reporting interim results from a retrospective chart-review study with select US headache centers and focusing on clinical versus medication use outcomes, Faust and colleagues [455] observed reductions in the mean number of migraine/head- ache days per month and the average duration of migraine/headache attacks, but also noted the continued use of a polypharmacy approach to management in their chronic migraine population.

Although there was an overall reduction in the use of acute medications, preven- tive medications, and healthcare resource utilization for migraine in the 6-month post-erenumab period, it is important to consider the differences observed between persistent and non-persistent patients.

For acute medications, the higher use of more expensive triptans in the post- erenumab period by erenumab-persistent patients was aligned with a small increase in associated costs.

Conclusion In this claims-based, retrospective observational study we observed reductions in claims for important migraine characteristics, comorbidities, and a shift to decreased use of acute and preventive migraine medications in the post-erenumab follow-up period—observations indicative of the real-world effectiveness of erenumab.

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Further examination is required as persistence to erenumab, which may be influ- enced by dose change, appears to be an important factor in changes to healthcare resource utilization and costs.

Acknowledgement A machine generated summary based on the work of Chandler, David; Szekely, Christine; Aggarwal, Shivani; Cyprien, Lori; Bensink, Mark. 2021  in Pain and Therapy.

Care Among Migraine Patients in a Commercially Insured Population