(134) Budget impact of Symbravo® (MoSEIC™ meloxicam and rizatriptan) to health plans in the United States for the acute treatment of migraine in adults

Background: : Migraine is a debilitating neurologic condition that often requires prompt and effective acute treatment to limit healthcare resource utilization; however, existing treatments are often suboptimal. Symbravo® (MoSEICTM meloxicam and rizatriptan [mMR]; formerly AXS-07), a novel, multimechanistic oral therapy, recently received US approval for the acute treatment of migraine with or without aura in adults.

Objective: : To estimate the budget impact of adding mMR to the formulary of a US third-party health plan (commercial or Medicare) for acute migraine treatment.

Methods: : A budget impact model was developed to estimate costs before and after the adoption of mMR to a health plan with 1 million covered lives over 3 years. This model included existing acute migraine therapies such as dihydroergotamine mesylate, gepants (rimegepant, ubrogepant, zavegepant), lasmiditan, and triptans (eletriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan). We sourced inputs from published literature, clinical trial data, and real-world prescription data. We assumed a 1.3% annual growth rate for migraine and a 1% annual market uptake for mMR. Eligible populations included adults aged 18–64 (commercial) and ≥65 years (Medicare) who receive prescription medications for acute migraine treatment. The model accounted for drug acquisition costs, adverse event management, rescue medication use in 2-hour nonresponders, and additional healthcare resource use (outpatient, emergency department, hospitalization) in 12-hour nonresponders. We compared total annual costs with and without mMR and conducted one-way sensitivity analyses.

Results: : In a commercial plan, mMR added $24,822, $50,289, and $76,415 to total annual costs in years 1–3, respectively, for 10,808, 10,948, and 11,090 patients treated for migraine. For Medicare, mMR added $46,603, $94,418, and $143,469 annually for 12,394, 12,555, and 12,719 patients. The modest increase in drug acquisition costs was largely offset by reductions in adverse event costs and healthcare resource utilization. Incremental per-member-per-month costs remained negligible over years 1-3: $0.0021, $0.0042, and $0.0064 for commercial and $0.0039, $0.0079, and $0.0120 for Medicare plans. Sensitivity analyses confirmed the robustness of these findings.

Conclusions: : mMR adoption at a 1% annual uptake for the acute treatment of migraine results in negligible budget impact for US health plans over a 3-year horizon. Its cost profile, coupled with reductions in associated healthcare resource use, supports its formulary inclusion.

Sponsorship:: Axsome Therapeutics, Inc.