title: Cost impact of a non-invasive, portable device for patient self-administration of chronic migraine in a UK National Health Service setting.
abstract: BACKGROUND
  Chronic migraine (CM) is a neurological disorder associated with substantial disability. Botulinum toxin type A (Botox) is an approved and effective preventive treatment option for adult patients with CM. Transcranial magnetic stimulation (TMS) is an alternative treatment device delivering a brief pre-set magnetic pulse used for self-administration by the patient at home. Despite being available in a risk share scheme TMS is perceived to be more costly in the UK. The objective of this study was to analyse the incremental costs of TMS compared to Botox in refractory CM patients both for a UK individual funding request setting as well as for an average UK specialist center setting.
  
  
  METHODS
  Cost impact results were derived from a decision-tree model simulating treatment pathways over 1 year. Costs were applied from the most recently available UK data sources. Sensitivity analysis was performed for all variables.
  
  
  RESULTS
  Based on published utilisation data 45.5 % of CM patients would continuously receive Botox over 1 year, whereas 53.7 % of TMS patients would be still on treatment at the end of year one. Total costs of Botox treatment accrue to £2923 in an individual funding request NHS cost setting, whereas TMS treatment results in £1466 in the first year. Applying a time-based NHS cost setting expenditures accrue to £1747 for the Botox treatment and to £1361 for the TMS treatment. In both cost settings variation of cost assumptions did have a minor impact on the cost increment from Botox to TMS.
  
  
  CONCLUSIONS
  The current risk share based remuneration model of TMS allows the UK NHS to reimburse only the cost of those patients experiencing reduction in migraine days resulting in lower costs for treating migraine attacks. Treatment of chronic refractory migraine using TMS implies a substantial cost reduction potential for the management of chronic treatment of refractory migraine patients compared to conventional Botox treatment.
authors.affiliation: Institute for Health Economics, Steinbeis-University, Berlin, Germany ; Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany.
authors.forename: B
authors.identifier: 0000-0002-8866-0809
authors.initials: B
authors.lastname: Brüggenjürgen
authors.affiliation: eNeura Inc., Sunnyvale, CA USA.
authors.forename: T
authors.initials: T
authors.lastname: Baker
authors.affiliation: eNeura Inc., Sunnyvale, CA USA.
authors.forename: R
authors.initials: R
authors.lastname: Bhogal
authors.affiliation: Neurosciences Business Unit, Hull and Yorkshire Hospitals NHS Trust, Hull, UK ; Hull York Medical School, Hull, UK.
authors.forename: F
authors.initials: F
authors.lastname: Ahmed
keywords: Botox; Chronic migraine; Economic analysis; Incremental costs; Pay for performance; Risk sharing; Self-administration; TMS