Abstract：
UNASSIGNED: Migraine is the most common disabling headache disorder and is characterized by recurrent throbbing head pain and symptoms of photophobia, phonophobia, nausea, and vomiting. Rimegepant 75 mg, an oral lyophilisate calcitonin gene-related peptide antagonist, is the first treatment approved for both the acute and preventative treatment of migraine, and the first acute therapy approved in over 20-years. The objective was to assess the cost-utility of rimegepant compared with best supportive care (BSC) in the UK, for the acute treatment of migraine in the adults with inadequate symptom relief after taking at least 2 triptans, or for whom triptans are contraindicated or not tolerated.
UNASSIGNED: A de novo model was developed to estimate incremental costs and quality-adjusted life years (QALYs), structured as a decision tree followed by Markov model. Patients received rimegepant or BSC for a migraine attack and were assessed for response (pain relief at 2-h). Responders and non-responders followed different pain trajectories over 48-h cycles. Non-responders discontinued treatment while responders continued treatment for subsequent attacks, with a proportion discontinuing over time. Data sources included a post-hoc pooled analysis of the phase 3 acute rimegepant trials (NCT03235479, NCT03237845, NCT03461757), and a long-term safety study (NCT03266588). The analysis was conducted from the perspective of the UK National Health Service and Personal Social Services over a 20-year time horizon.
UNASSIGNED: Rimegepant resulted in an incremental cost-utility ratio (ICUR) of £10,309 per QALY gained vs BSC, which is cost-effectiveness at a willingness to pay threshold of £30,000/QALY. Rimegepant generated +0.44 incremental QALYs and higher incremental lifetime costs (£4,492). Improved QALYs for rimegepant were a result of less time spent with severe and moderate headache pain.
UNASSIGNED: This study highlights the economic value of rimegepant which was found to be cost-effective for the acute treatment of migraine in adults unsuitable for triptans.
UNASSIGNED: A de novo model was developed to estimate incremental costs and quality-adjusted life years (QALYs), structured as a decision tree followed by Markov model. Patients received rimegepant or BSC for a migraine attack and were assessed for response (pain relief at 2-h). Responders and non-responders followed different pain trajectories over 48-h cycles. Non-responders discontinued treatment while responders continued treatment for subsequent attacks, with a proportion discontinuing over time. Data sources included a post-hoc pooled analysis of the phase 3 acute rimegepant trials (NCT03235479, NCT03237845, NCT03461757), and a long-term safety study (NCT03266588). The analysis was conducted from the perspective of the UK National Health Service and Personal Social Services over a 20-year time horizon.
UNASSIGNED: Rimegepant resulted in an incremental cost-utility ratio (ICUR) of £10,309 per QALY gained vs BSC, which is cost-effectiveness at a willingness to pay threshold of £30,000/QALY. Rimegepant generated +0.44 incremental QALYs and higher incremental lifetime costs (£4,492). Improved QALYs for rimegepant were a result of less time spent with severe and moderate headache pain.
UNASSIGNED: This study highlights the economic value of rimegepant which was found to be cost-effective for the acute treatment of migraine in adults unsuitable for triptans.
摘要：
偏头痛是最常见的致残性头痛病，其特征是反复跳动的头部疼痛和畏光症状，恐惧症,恶心,和呕吐。Rimegepant75mg,口服冻干降钙素基因相关肽拮抗剂，是第一种被批准用于偏头痛的急性和预防性治疗的治疗方法，也是20多年来获得批准的第一个急性疗法。目的是评估rimegepant与英国最佳支持治疗（BSC）相比的成本效用，对于在服用至少2种曲坦类药物后症状缓解不足的成人偏头痛的急性治疗，或者曲坦禁忌或不耐受的人。
■开发了一个从头模型来估计增量成本和质量调整寿命年（QALYs），构造为决策树，后跟马尔可夫模型。患者接受了偏头痛发作的Rimegepant或BSC，并评估了反应（2小时后疼痛缓解）。响应者和非响应者在48小时周期内遵循不同的疼痛轨迹。无应答者停止治疗，而应答者继续治疗随后的攻击，随着时间的推移，有一部分会中断。数据来源包括对3期急性Rimegepant试验的事后汇总分析（NCT03235479，NCT03237845，NCT03461757），和长期安全性研究（NCT03266588）。该分析是在20年的时间范围内从英国国家卫生服务和个人社会服务的角度进行的。
■Rimegepant导致每QALY相对于BSC的增量成本效用比（ICUR）为10,309英镑，这是愿意支付30,000英镑/QALY门槛的成本效益。Rimegepant产生了+0.44个增量QALY和更高的增量生命周期成本（4,492英镑）。改善Rimegepant的QALY是由于减少了严重和中度头痛的时间。
■这项研究强调了rimegepant的经济价值，发现rimegepant对于不适合曲坦的成人偏头痛的急性治疗具有成本效益。
■开发了一个从头模型来估计增量成本和质量调整寿命年（QALYs），构造为决策树，后跟马尔可夫模型。患者接受了偏头痛发作的Rimegepant或BSC，并评估了反应（2小时后疼痛缓解）。响应者和非响应者在48小时周期内遵循不同的疼痛轨迹。无应答者停止治疗，而应答者继续治疗随后的攻击，随着时间的推移，有一部分会中断。数据来源包括对3期急性Rimegepant试验的事后汇总分析（NCT03235479，NCT03237845，NCT03461757），和长期安全性研究（NCT03266588）。该分析是在20年的时间范围内从英国国家卫生服务和个人社会服务的角度进行的。
■Rimegepant导致每QALY相对于BSC的增量成本效用比（ICUR）为10,309英镑，这是愿意支付30,000英镑/QALY门槛的成本效益。Rimegepant产生了+0.44个增量QALY和更高的增量生命周期成本（4,492英镑）。改善Rimegepant的QALY是由于减少了严重和中度头痛的时间。
■这项研究强调了rimegepant的经济价值，发现rimegepant对于不适合曲坦的成人偏头痛的急性治疗具有成本效益。
