Abstract Details

Title Real-World Persistence and Costs Among Patients With Chronic Migraine Treated With OnabotulinumtoxinA or CGRP mAbs: A Retrospective Claims Analysis Study

Topic Headache

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-004

Background Persistence with oral migraine preventive medications (OMPMs) is reportedly low. Real-world data on treatment persistence and costs associated with recently approved preventive CM treatments are limited.

Objective Evaluate real-world persistence rates and costs among patients with chronic migraine (CM) treated with onabotulinumtoxinA (onabotA [BOTOX^®]) or calcitonin gene–related peptide monoclonal antibody (CGRP mAb).

Design/Methods This retrospective, longitudinal, observational study analyzed the IBM MarketScan^® Commercial and Medicare Supplemental databases (7/1/2017-2/29/2020). Adults treated with either onabotA or CGRP mAbs (based on overall migraine ICD-10 codes) and having continuous coverage ≥6 months before and ≥12 months after treatment initiation were included. Persistence to index treatment was assessed at 6, 9, and 12 months, and all-cause and migraine-related costs were evaluated during the 12-month follow-up period. Persistence and costs were adjusted for potential confounders (demographics, comorbidities, OMPM use) using generalized linear model regression.

Results Of 66,303 patients with onabotA or CGRP mAb claims, 2697 patients with CM met inclusion/exclusion criteria. In the total population, patients were primarily female (86%) and their mean age was 44 years, which was consistent among the individual CGRP mAbs. Persistence was higher among those treated with onabotA versus the combined CGRP mAbs group at 6 (67% vs 47%; P<0.001), 9 (51% vs 37%; P<0.001), and 12 (40% vs 27%; P<0.001) months. OnabotA and CGRP mAbs were associated with comparable 12-month all-cause ($16,681 vs $16,666) and migraine-related ($8198 vs $8518) costs. Compared to CGRP mAbs, onabotA was associated with lower 12-month acute medication ($763 vs $1240; P<0.001), OMPM ($685 vs $993; P<0.01), and migraine-related inpatient ($224 vs $728; P<0.01) costs. Migraine-related emergency department costs were comparable between onabotA and CGRP mAbs ($149 vs $129). Findings were sustained after regression adjustment for confounders.

Conclusions CM patients initiating onabotA treatment had higher persistence and comparable all-cause and migraine-related costs over 12 months compared to CGRP mAbs.

Authors/Disclosures
Patrick J. Gillard, PharmD, MS PRESENTER	Mr. Gillard has received personal compensation for serving as an employee of AbbVie. Mr. Gillard has stock in AbbVie.
Todd J. Schwedt, MD, FAAN (Mayo Clinic)	Dr. Schwedt has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Allergan. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli Lilly. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Satsuma. Dr. Schwedt has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biodelivery Science. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Axsome. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Collegium. Dr. Schwedt has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Linpharma. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Theranica. Dr. Schwedt has received personal compensation in the range of $0-$499 for serving as a Consultant for Amgen. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Scilex. Dr. Schwedt has stock in Aural Analytics. Dr. Schwedt has stock in Nocira. The institution of Dr. Schwedt has received research support from Amgen. The institution of Dr. Schwedt has received research support from National Institutes of Health. The institution of Dr. Schwedt has received research support from United States Department of Defense. The institution of Dr. Schwedt has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Schwedt has received research support from SPARK Neuro. The institution of Dr. Schwedt has received research support from Henry Jackson Foundation. Dr. Schwedt has received intellectual property interests from a discovery or technology relating to health care. Dr. Schwedt has received publishing royalties from a publication relating to health care.
	No disclosure on file
Kerry L. Knievel, DO (Barrow Neurological Institute)	Dr. Knievel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie . Dr. Knievel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biohaven . Dr. Knievel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck . Dr. Knievel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lilly. Dr. Knievel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Pfizer. Dr. Knievel has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck . Dr. Knievel has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie . Dr. Knievel has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen . Dr. Knievel has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven . Dr. Knievel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Lundbeck . Dr. Knievel has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Headache Cooperative of the Pacific . The institution of Dr. Knievel has received research support from Abbvie .
Jennifer W. McVige, MD (Dent Neurological Institute)	Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theranica. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Allergan/AbbVie. Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eli Lilly. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Teva. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Neurelis. The institution of Dr. McVige has received research support from Amgen. The institution of Dr. McVige has received research support from Eli Lily. The institution of Dr. McVige has received research support from Biohaven. The institution of Dr. McVige has received research support from Lundbeck. The institution of Dr. McVige has received research support from Dent Family Foundation. Dr. McVige has a non-compensated relationship as a Neurology Board with UCNS that is relevant to AAN interests or activities. Dr. McVige has a non-compensated relationship as a Board Exam Board Member with ABPN that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
Darshini Shah, Other (AbbVie Inc)	Ms. Shah has received personal compensation for serving as an employee of AbbVie. Ms. Shah has stock in AbbVie Inc. An immediate family member of Ms. Shah has received research support from National Institutes of Health.
Andrew M. Blumenfeld, MD, FAAN (The Los Angeles Headache Center)	Dr. Blumenfeld has received personal compensation for serving as an employee of The Los Angeles Headache Center. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Allergan. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Best Doctors. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GLG. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theranica. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Aeon. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Revance. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lilly. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Abbvie. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aeon. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Revance. Dr. Blumenfeld has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theranica. Dr. Blumenfeld has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Axsome. Dr. Blumenfeld has received personal compensation in the range of $100,000-$499,999 for serving on a Speakers Bureau for Allergan. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. Blumenfeld has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Teva. Dr. Blumenfeld has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Lilly. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biohaven. Dr. Blumenfeld has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Lundbeck.