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    Benefit design and management

    E-Poster Available

    (10) Economic impact of early vs. late initiation of atogepant for the preventive treatment of migraine

    Wednesday, October 29, 2025

      Primary Author(s)

    • Jessica Ailani, MD

      Associate Professor of Neurology
      Medstar Georgetown University Hospital, Washington, DC, USA
      Washington, District of Columbia, United States

      • Co-Author(s)

    • Anjana Lalla, MS

      Director, Medical Affairs and HEOR
      AbbVie, at the time of the study
      North Chicago, Illinois, United States

      • Presenter(s)

    • Pranav Gandhi, PhD

      Director, HEOR
      AbbVie, Madison, NJ, USA
      Madison, New Jersey, United States

      • Co-Author(s)

    • Karen Carr, PhD

      Scientific Director
      AbbVie
      North Chicago, Illinois, United States

    • Brett Dabruzzo, PharmD

      Director, Medical Affairs
      AbbVie, Madison, NJ, USA
      North Chicago, Illinois, United States

    • Rashmi Halker Singh, MD

      Professor
      Mayo Clinic
      Phoenix, Arizona, United States

    • Richard B. Lipton, MD

      Neurologist
      Albert Einstein College of Medicine, Bronx, NY, USA
      Bronx, New York, United States


    Background:     : Atogepant is an oral calcitonin gene-related peptide receptor (CGRP) antagonist approved for the preventive treatment of migraine. US payors typically require 1- or 2-step edits of non-specific oral generic preventive medications before allowing access to atogepant.

    Objective: : Evaluate the economic impact of removing step edits prior to initiating atogepant for the preventive treatment of migraine, from a US payor perspective.

    Methods: : An Excel-based economic model was developed to estimate 1-year direct cost savings associated with removing step edits before access to atogepant from a US payor’s perspective. Efficacy in the model was assessed 2 months after treatment initiation using 50% responder rate data derived from a previously published network meta-analysis of atogepant versus CGRP monoclonal antibodies and oral generics. Direct costs included wholesale acquisition costs of preventive and acute migraine treatments, neurologist and administrative cost per step edit, and migraine-related healthcare resource utilization (HCRU) costs. Patients who failed current oral generic treatment (non-responders) moved to the next oral generic or atogepant. After each step edit, non-responders may stop seeking preventive treatment, returning to their baseline migraine burden and incurring high HCRU and acute medication costs for the remaining time horizon.

    Results: : Total annual direct costs for patients who have 2-step edits, 1-step edit, and 0-step edits were calculated as $12,120, $11,863, and $10,839, respectively. The biggest driver for cost savings was associated with migraine-related HCRU leading to an annual costs savings of $1281 per patient when reducing from 2-step edits to 0-step edits. Reducing 1-step edit to 0-step edits resulted in annual costs savings of $1024 per patient.

    Conclusions: : Reducing 2-step edits / 1-step edit to 0-step edits for atogepant demonstrated annual cost savings of more than $1,000 per patient for US payors. These model-based estimates should be assessed in randomized trials of benefit designs.

    Sponsorship:: AbbVie