Cost-Effectiveness Analysis of Rimegepant Versus Eletriptan for Patients with Acute Episodic Migraine in Thailand: Establishing Dominance from a Societal Perspective

Jadesada  Lertsirimunkong; Wiwat Thavornwattanayong; Jidapha  Pradab; Jidapa  Khongbun; Kitiphong  Khunphong; Nattanun  Panyasrilert

doi:10.33192/smj.v78i9.282940

Authors

Jadesada Lertsirimunkong Department of Social and Administrative Pharmacy, College of Pharmacy, Rangsit University, Pathum Thani, Thailand
Wiwat Thavornwattanayong Health Innovation and Research Outcomes Group, Faculty of Pharmacy, Silpakorn University, Nakorn-pathom, Thailand
Jidapha Pradab Faculty of Pharmacy, Silpakorn University, Nakorn-pathom, Thailand
Jidapa Khongbun Faculty of Pharmacy, Silpakorn University, Nakorn-pathom, Thailand
Kitiphong Khunphong Faculty of Pharmacy, Silpakorn University, Nakorn-pathom, Thailand
Nattanun Panyasrilert Faculty of Pharmacy, Silpakorn University, Nakorn-pathom, Thailand

DOI:

https://doi.org/10.33192/smj.v78i9.282940

Keywords:

Migraine, Cost-effectiveness, ICER, Rimegepant, CGRP, Eletriptan   

Abstract

Objective: For acute migraine patients unresponsive to sumatriptan, the choice is between another triptan, eletriptan, and the novel CGRP antagonist, rimegepant. As of now, no cost-effectiveness analysis comparing rimegepant and eletriptan has been conducted in Thailand. This study aims to evaluate the cost-effectiveness of rimegepant and eletriptan for the treatment of acute episodic migraine in Thailand using data from the Thai healthcare system.

Materials and Methods: This study was a health economic evaluation using a lifetime decision tree–Markov model with 30-day cycles, from a societal perspective. Total costs and quality-adjusted life years (QALYs) were projected using effectiveness data from a systematic review, cost data from Thai healthcare databases, and utility values from published literature. The incremental cost-effectiveness ratio (ICER) was evaluated, and uncertainty was assessed through sensitivity analyses.

Results: The results revealed that, using a 3% discount rate and 2025 costs, the total cost of treatment with rimegepant for acute episodic migraine in Thailand was 2,442,622.42 THB, yielding 25.21 QALYs. In comparison, treatment with eletriptan incurred a total cost of 2,450,782.33 THB and yielded 17.59 QALYs. The ICER of rimegepant compared with eletriptan was −1,071.79 THB per QALY gained. Therefore, rimegepant was considered a dominant strategy, as it generated more QALYs while incurring lower overall costs than eletriptan.

Conclusion: Rimegepant has demonstrated cost-effectiveness in treating acute episodic migraine in Thailand, as it is a dominant strategy, generating higher QALYs while incurring lower overall costs. This economic evidence would help policymakers make informed decisions.

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