Interventions of Interest:
- ubrogepant (Ubrelvy™, Allergan)
- rimegepant (Nurtec™, Biohaven Pharmaceuticals)
- lasmiditan (Reyvow™, Lilly)
Migraine is a common cause of headache and is characterized by episodic, recurrent attacks that are classically pulsatile or throbbing, frequently involve one side of the head, and are associated with nausea and sensitivity to external stimuli such as light, sound, and smells. Migraine attacks vary in their frequency and intensity, but when severe can be a disabling, chronic condition that can impact all aspects of life including personal relationships and ability to work. An estimated 40 million adults or 12-15% of adults in the United States (US) report migraine or severe headaches.
Evidence on new agents lasmiditan, ubrogepant, and rimegepant judged inadequate to demonstrate superiority over more affordable triptans. The policy discussion focused on important role of these new agents for patients not eligible for triptans or who do not receive adequate relief after trying several different triptans. Further analysis of data provided by Allergan lead to updated economic model results and improved cost-effectiveness findings for the “gepant” class of migraine treatments.
Below you will find the final documents from the assessment review process:
“For patients who are unable to take triptans or who don’t get adequate benefit from those more affordable options, these new migraine therapies appear to relieve migraine symptoms in 10-20% more patients than who respond to placebo. Following the publication of the previous iteration of our report, we worked closely with Allergan to identify high-quality evidence demonstrating additional clinical benefits for ubrogepant beyond the two-hour time point required by the FDA for the clinical trials. This additional benefit, which likely also applies to rimegepant, supports a near doubling of ICER’s health-benefit price benchmark for these two treatments, and is also a key example of how ICER works closely with stakeholders to ensure we have the best evidence-based approach to capturing the full value of a product.”