Cost-Effectiveness of Long-term, Targeted Onabotulinumtoxina Versus Peripheral Nerve Decompression Surgery for the Treatment of Migraine Headaches

Abstract

BACKGROUND: Chronic migraines affect approximately 2% of the US population and cost an estimated $17 billion per year. OnabotulinumtoxinA (botulinum toxin type A [BoNTA]) is an Food and Drug Administration-approved prophylactic medication for chronic migraine headaches and is best injected in a targeted fashion into specific trigger sites. The purpose of this study is to determine the cost-effectiveness of long-term, targeted BoNTA versus peripheral nerve decompression surgery for the treatment of migraine headaches. METHODS: A Markov model was constructed to examine long-term, targeted BoNTA versus peripheral nerve decompression surgery. Costs, utilities, and other model inputs were identified from the literature. One-way and probabilistic sensitivity analyses were performed. An incremental cost-effectiveness ratio under $50,000 per quality adjusted life year was considered cost-effective. RESULTS: The mean cost of peripheral nerve decompression surgery was $10,303 with an effectiveness of 7.06, whereas the mean cost of long-term, targeted BoNTA was $36,071 with an effectiveness of 6.34. Decompression surgery is more effective and less costly over the time horizon of the model. One-way sensitivity analysis revealed that surgery is the most cost-effective treatment in patients requiring treatment for >6.75 years. CONCLUSION: Based on this model, peripheral nerve decompression surgery is the more cost-effective option for treating refractory migraine headaches requiring treatment beyond 6.75 years. The model reveals that peripheral nerve decompression surgery is more effective and less costly than long-term, targeted BoNTA over the course of a patient’s lifetime.