Migraine is one of the main causes of disability worldwide. Anti-CGRP monoclonal antibodies (MAbs) have proven to be safe and efficacious as preventive migraine treatments. However, their use is restricted in many countries due to their apparently high cost. Cost-benefit studies are needed. To study the cost-benefit of anti-CGRP MAbs in working-age patients with migraine. This is a prospective cohort study of consecutive migraine patients treated with anti-CGRP MAbs (erenumab, fremanezumab and galcanezumab) following National reimbursement policy in a specialized headache clinic. Migraine characteristics and the work impact scale (WPAI) were compared between baseline (M0) and after 3 (M3) and 6 months (M6) of treatment. Using WPAI and the municipal average hourly wage, we calculated indirect costs (absenteeism and presenteeism) at each time point. Direct costs (emergency visits, acute medication use) were also analysed. A cost-benefit study was performed considering the different costs and savings of treating with MAbs. Based on these data an annual projection was conducted. From 256 treated working-age patients, 148 were employed (89.2% women; mean age 48.0 ± 8.5 years), of which 41.2% (61/148) were responders (> 50% reduction in monthly headache days (MHD)). Statistically significant reductions between M0 and M3/M6 were found in absenteeism (p < 0.001) and presenteeism (p < 0.001). Average savings in indirect costs per patient at M3 were absenteeism 105.4 euros/month and presenteeism 394.3 euros/month, similar for M6. Considering the monthly cost of anti-CGRP MAbs, the cost-benefit analysis showed savings of 159.8 euros per patient at M3, with an annual projected savings of 639.2 euros/patient. Both responders and partial responders (30–50% reduction in MHD) presented a positive cost-benefit balance. The overall savings of the cohort at M3/M6 compensated the negative cost-benefit balance for non-responders (< 30% reduction in MHD). Anti-CGRP MAbs have a positive impact in the workforce significantly reducing absenteeism and presenteeism. In Spain, this benefit overcomes the expenses derived from their use already at 3 months and is potentially sustainable at longer term; also in patients who are only partial responders, prompting reconsideration of current reimbursement criteria and motivating the extension of similar cost-benefit studies in other countries.

中文翻译：

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抗 CGRP 单克隆抗体预防偏头痛的早期和年度预计节省：工作年龄人群的成本效益分析

偏头痛是全世界残疾的主要原因之一。抗 CGRP 单克隆抗体 (MAb) 已被证明是安全有效的预防性偏头痛治疗方法。然而，由于成本明显较高，许多国家的使用受到限制。需要进行成本效益研究。研究抗 CGRP 单克隆抗体在工作年龄偏头痛患者中的成本效益。这是一项前瞻性队列研究，对象是按照国家报销政策在专业头痛诊所接受抗 CGRP 单克隆抗体（erenumab、fremanezumab 和 galcanezumab）连续治疗的偏头痛患者。比较基线 (M0) 与治疗 3 个月 (M3) 和 6 个月 (M6) 后的偏头痛特征和工作影响量表 (WPAI)。使用 WPAI 和市平均小时工资，我们计算了每个时间点的间接成本（缺勤和出勤）。还分析了直接成本（紧急就诊、急性药物使用）。考虑到单克隆抗体治疗的不同成本和节省，进行了成本效益研究。根据这些数据进行了年度预测。在 256 名接受治疗的工作年龄患者中，有 148 人就业（89.2% 为女性；平均年龄 48.0 ± 8.5 岁），其中 41.2% (61/148) 为缓解者（每月头痛天数 (MHD) 减少 50% 以上）。 M0 和 M3/M6 之间的缺勤率 (p < 0.001) 和出勤率 (p < 0.001) 显着下降。 M3 每位患者平均节省的间接成本为缺勤 105.4 欧元/月，缺勤 394.3 欧元/月，与 M6 类似。考虑到抗 CGRP 单克隆抗体的每月成本，成本效益分析显示，M3 时每位患者可节省 159.8 欧元，预计每年可节省 639.2 欧元/患者。应答者和部分应答者（MHD 减少 30-50%）均呈现出积极的成本效益平衡。 M3/M6 队列的总体节省补偿了无应答者的负成本效益平衡（MHD 减少 < 30%）。抗 CGRP 单克隆抗体对劳动力产生积极影响，显着减少缺勤和出勤现象。在西班牙，这种好处可以抵消 3 个月后使用所产生的费用，并且有可能长期持续；也适用于仅部分缓解的患者，促使重新考虑当前的报销标准，并促使在其他国家推广类似的成本效益研究。