NICE has published final draft guidance which recommends erenumab (Aimovig) for preventing migraine. The decision marks a u-turn on the agency’s previous conclusion not to approve the treatment based on cost-effectiveness.
In the original draft guidelines, NICE concluded that, assuming erenumab works only as well as botulinum toxin type A, cost-effective estimates for erenumab in chronic migraine were higher than normally considered an acceptable use of NHS resources.
For episodic migraine, expert opinion was that this is not a clinically distinct subgroup. Erenumab was not recommended for preventing migraine in adults who have at least four migraine days per month.
The British Association for the Study of Headache (BASH) and the Association of British Neurologists (ABN) appealed the decision. The appeal was upheld on the grounds that NICE had failed to consider the cost-effectiveness of erenumab versus best supportive care in patients with chronic migraine who had failed to benefit from botulinum toxin.
Following the outcome of the appeal, NICE invited Novartis to submit further evidence relating to the clinical- and cost-effectiveness of erenumab for treating chronic migraine following the failure of treatment with botulinum toxin, or when botulinum toxin is not tolerated or contraindicated.
NICE felt that there is now sufficient evidence to accept erenumab as a cost-effective use of NHS resource in the population who had tried at least three prior treatments. The committee concluded that erenumab could be recommended as an option for people with episodic and chronic migraine.
The revised draft guidance recommends erenumab in adults who have at least four migraine days each month and where at least three previous preventive treatments have failed.
This guidance is open to appeal until 5pm, Thursday 7 January 2021. The expected date for publication of a final decision is 27 January 2021.
