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Cost-Effectiveness of Long-term, Targeted Onabotulinumtoxina Versus Peripheral Nerve Decompression Surgery for the Treatment of Migraine Headaches

Schoenbrunner, Anna MD, MAS; Khansa, Ibrahim MD; Janis, Jeffrey E. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 46-47
doi: 10.1097/01.GOX.0000584460.29359.f6
Craniofacial Abstracts

The Ohio State University, Columbus, OH

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: Chronic migraines affect approximately 2% of the US population and cost an estimated $17 billion per year. OnabotulinumtoxinA (botulinum toxin type A [BoNTA]) is an Food and Drug Administration-approved prophylactic medication for chronic migraine headaches and is best injected in a targeted fashion into specific trigger sites. The purpose of this study is to determine the cost-effectiveness of long-term, targeted BoNTA versus peripheral nerve decompression surgery for the treatment of migraine headaches.

METHODS: A Markov model was constructed to examine long-term, targeted BoNTA versus peripheral nerve decompression surgery. Costs, utilities, and other model inputs were identified from the literature. One-way and probabilistic sensitivity analyses were performed. An incremental cost-effectiveness ratio under $50,000 per quality adjusted life year was considered cost-effective.

RESULTS: The mean cost of peripheral nerve decompression surgery was $10,303 with an effectiveness of 7.06, whereas the mean cost of long-term, targeted BoNTA was $36,071 with an effectiveness of 6.34. Decompression surgery is more effective and less costly over the time horizon of the model. One-way sensitivity analysis revealed that surgery is the most cost-effective treatment in patients requiring treatment for >6.75 years.

CONCLUSION: Based on this model, peripheral nerve decompression surgery is the more cost-effective option for treating refractory migraine headaches requiring treatment beyond 6.75 years. The model reveals that peripheral nerve decompression surgery is more effective and less costly than long-term, targeted BoNTA over the course of a patient’s lifetime.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.