Utilisation, expenditure, and treatment patterns associated with calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) reimbursed subject to a managed access protocol in Ireland.

Abstract

ObjectiveCalcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are novel high-cost treatments for the prevention of migraine. This study presents data on utilisation, expenditure and treatment patterns with CGRP mAbs available under a managed access protocol in Ireland, to a cohort of treatment refractory patients (failed three or more previous treatments) with chronic migraine. MethodsData was extracted from the Primary Care Reimbursement Service (PCRS) High Tech claims database and special drug request online system, and analysed using Microsoft Excel and SAS. Treatment persistence was evaluated by refill patterns, and adherence was evaluated using the proportion of days covered method. Expenditure data was extracted directly from the database. ResultsBetween 1st September 2021 and 30th April 2023, 1,517 applications for reimbursement approval for a CGRP mAb were received; 1,458 (96.1%) were approved for reimbursement. Total expenditure on CGRP mAbs in year one (1st September 2021 to 31st August 2022) was €3.2 million. The majority of patients initiated treatment with fremanezumab (60.8%) or erenumab (37.1%). Almost 90% of patients were considered adherent, and treatment persistence was high, with more than 75% of patients receiving more than 12 months of treatment in our 18-month study time-frame. ConclusionsThis study demonstrates the importance of active health technology management, post-reimbursement, in enabling cost-effective use of high-cost treatments while providing budget certainty for the healthcare payer. High levels of adherence and persistence suggest treatment is successfully targeted where unmet clinical need is greatest.