In its new draft guidance, the National Institute for Health and Care Excellence (NICE) has said that a new drug for preventing migraine is not cost-effective for routine use in the NHS. The therapy is estimated to cost £5000 per year (excluding a price discount which would have been applicable if it was recommended by NICE).
The guidance pertains to the self-injected drug erenumab (Aimovig) for preventing chronic and episodic migraine in adults with ≥4 episodes every month and when at least 3 preventive treatments have failed in the past. Erenumab targets the process through which proteins cause blood vessel swelling in the brain resulting in migraine symptoms.
For chronic migraine, at least 3 oral preventive treatments are typically tried before considering more specialist treatment. Currently, NICE recommends botulinum toxin type A for patients in whom at least 3 oral preventive treatments have failed. There was inadequate evidence to indicate that erenumab has better efficacy than botulinum toxin type A for individuals with chronic migraine. Also, there was no evidence to support its long-term efficacy for patients with 3 previously failed treatments. NICE believes the cost-effectiveness estimates for erenumab are more than what it considers acceptable when evidence is uncertain.
Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: "We will work with the company to ensure that they are given every opportunity to address the issues highlighted in these provisional recommendations."