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.