Cost-Effectiveness of Long-Term, Targeted OnabotulinumtoxinA versus Peripheral Trigger Site Deactivation Surgery for the Treatment of Refractory Migraine Headaches.

BACKGROUND: Chronic migraines affect approximately 2% of the United States population and cost an estimated $17 billion per year. OnabotulinumtoxinA (BoNTA) is an FDA-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 trigger site deactivation surgery for the treatment of migraine headaches.

METHODS: A Markov model was constructed to examine long-term, targeted BoNTA versus peripheral trigger site deactivation 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 trigger site deactivation surgery was $10,303 with an effectiveness of 7.06, while the mean cost of long term, targeted BoNTA was $36,071 with an effectiveness of 6.34. Trigger site deactivation 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 greater than 6.75 years.

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