Abstract / Summary
Abstract Objectives This study evaluated the cost-effectiveness of atogepant, an oral calcitonin gene-related peptide (CGRP) receptor antagonist, for the preventive treatment of episodic migraine in adults from the perspective of Taiwan’s National Health Insurance (NHI) system. Methods A cost-utility analysis was conducted using a Markov model over a 1-year time horizon with 12-week cycles. The model incorporated treatment discontinuation, direct medical costs, and state-specific health utilities. Transition probabilities were derived from the Phase III ADVANCE trial. Costs of outpatient visits, emergency care, and hospitalization were obtained from Taiwan’s NHI claims data. Study outcomes included incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty, together with scenario analyses extending the time horizon to 2 years and retaining an alternative utility source. Results The base-case analysis revealed that atogepant was associated with an incremental cost of $1,766 and a QALY gain of 0.032 compared with placebo. This resulted in an ICER of $55,749 per QALY gained, which was between one and two times Taiwan’s gross domestic product (GDP) per capita ($34,040 to $68,080). One-way sensitivity analysis identified the health state utility for 0–3 MMDs as the most influential driver of cost-effectiveness. Probabilistic sensitivity analysis showed that the probability of atogepant being cost-effective was 2.9% at one time Taiwan’s GDP per capita, 74.4% at two times the GDP per capita, and 96.0% at three times GDP per capita, exceeding 50% once WTP surpassed $56,300. Conclusions This study represents a baseline, proof-of-concept economic assessment of atogepant against placebo, yielding an ICER falling between one and two times Taiwan’s GDP per capita in the base-case analysis. However, these results require cautious interpretation as model outcomes are heavily driven by non-local utility inputs. Future evaluations should integrate Taiwan-specific quality-of-life data and network meta-analyses against active preventive therapies. Clinical trial number Not applicable.