Treatment Patterns and Healthcare Resource Utilization by Gender and Migraine Frequency in Adult Patients Receiving Galcanezumab Versus Standard of Care Preventive Medications Over 24 months: A United States Retrospective Claims Study

Oralee J Varnado,1 Michelle Vu,2 Erin K Buysman,2 Gilwan Kim,1 Gayle Allenback,2 Margaret Hoyt,1 Helen Trenz,2 Feng Cao,2 Lars Viktrup1 1Eli Lilly and Company, Indianapolis, IN, USA; 2Optum Life Sciences, HEOR, Eden Prairie, MN, USACorrespondence: Oralee J Varnado, Value, Evidence, and Outcomes, Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, IN, 46285, USA, Tel +1 317-277-0599, Email [email protected]: To describe 24-month treatment patterns, healthcare resource utilization (HCRU), and direct costs of patients initiating galcanezumab (GMB) versus standard of care migraine preventive medications (SOC), stratified by gender and migraine type.Methods: This retrospective cohort study used Optum’s® de-identified Market Clarity database (September 2018−March 2020) and included adults with migraine with ≥ 1 claim for GMB or SOC. Patients in the GMB cohort were stratified by gender (female/male) and migraine type (CM/EM), and propensity score matched 1:1 to patients in the SOC cohort. Treatment patterns, all-cause and migraine-related HCRU, and direct costs for GMB versus SOC cohorts were compared using a Z-test and reported over 24 months.Results: Following stratification and matching, the GMB and SOC cohorts included the following patient pairs: 2015-female, 292-male, 1024-CM, and 1282-EM. Treatment adherence, measured by proportion of days covered, and median time to treatment discontinuation were significantly greater in those initiating GMB compared with SOC in females, males, patients with CM, and patients with EM (all p < 0.001). Over 24 months, reduction in migraine-related ambulatory visits, office visits, and medical costs were significantly higher in GMB versus SOC cohorts in females and patients with CM. Increases in HCRU associated with preventive migraine medication counts and migraine-related total and pharmacy costs were significantly higher in GMB versus SOC cohorts in all subgroups.Conclusion: While direct costs over 24 months were higher in patients initiating GMB for migraine prevention, better adherence and longer treatment duration with GMB regardless of gender or migraine type support the use of GMB compared with SOC.Plain Language Summary: What was known before?The risk of migraine is about two to three times higher for women than for men.Migraine is broadly classified into episodic migraine (EM, 14 or fewer migraine headache days per month) and chronic migraine (CM, at least 15 migraine headache days per month for at least 3 months) based on frequency of monthly migraine headache days. Individuals with CM appear to have higher rates of comorbid conditions than those with EM.Traditional standard of care migraine preventive medications (SOC) were not specifically developed for migraine treatment, and more than half of patients stop using oral medications prematurely.Calcitonin gene-related peptide monoclonal antibodies such as galcanezumab (GMB), fremanezumab, erenumab, and eptinezumab provide migraine-specific preventive treatment.Previous studies with 6-, 12-, and 24-month follow-ups have described the treatment patterns and healthcare resource utilization (HCRU) after initiation of GMB versus SOC.What does this study add?In this 24-month study, we divided a population of patients starting GMB or SOC for migraine prevention 1) based on their gender (female or male) and 2) based on the type of migraine they reported (CM or EM), and compared treatment patterns, HCRU, and direct costs.Irrespective of gender and migraine type, patients who started GMB used their medicine as prescribed for a longer period of time than those who started SOC.Irrespective of gender and migraine type, following initiation of GMB, all-cause and migraine-related total costs increased, with the increase primarily driven by increased pharmacy costs.InterpretationPatients with migraine initiating GMB as their preventive treatment are more likely to continue using it for a longer duration compared with those initiating SOC, based on better adherence and persistence rates. While total costs were higher in patients initiating GMB compared with those initiating SOC, some reductions were observed in HCRU.Treatment patterns, HCRU, and direct costs were generally consistent between females and males as well as those with CM and EM.Keywords: CGRP mAbs, treatment patterns, direct costs, healthcare resource utilization, migraine prevention