![]() Migraine is a common neurological disorder characterised by debilitating, recurrent headaches, often divided into episodic (EM) and chronic (CM) forms based on month headache days (MHD) and monthly migraine days (MMD) (EM, 4–14 MMD and < 15 MHD, or CM, ≥15 MHD and ≥ 8 MMD). Such models have implications for use in a wide range of disease areas when assessing repeated measured utility values. Modelling MMD using negative binomial and beta-binomial distributions can be advantageous because these models can capture intra- and inter-patient variability so that trial observations can be modelled parametrically for the purposes of economic evaluation of migraine prevention. This proposed methodology, which has not been previously applied in migraine, has shown that these models may be suitable for estimating MMD frequency. Using the erenumab study data, both the negative binomial and beta-binomial models provided unbiased estimates relative to observed trial data with well-fitting distribution at various time points. For a thorough comparison we also present the fitting from the standard multilevel Poisson and the zero inflated negative binomial. For each trial, two longitudinal regression models were fitted: negative binomial and beta binomial. MMD observations from the double-blind phases of two studies of erenumab were used: one in episodic migraine (EM) (NCT02456740) and one in chronic migraine (CM) (NCT02066415). In this analysis, parametric models of change in MMD for migraine preventives were assessed using data from erenumab clinical studies. Using these cohort-level endpoints in economic models, accounting for variation among patients is challenging. Many clinical trials report outcomes using the frequency of an event over a set period of time, for example, the primary efficacy outcome in most clinical trials of migraine prevention is mean change in the frequency of migraine days (MDs) per 28 days (monthly MDs ) relative to baseline for active treatment versus placebo. Health economic models are critical tools to inform reimbursement agencies on health care interventions. ![]()
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