BACKGROUND: Current preventive migraine medicines are associated with poor adherence and tolerability. There is an unmet need for effective migraine-specific preventive treatments with fewer adverse events (AEs).
OBJECTIVE: To understand treatment preferences of people with migraine and the relative importance of improvements in efficacy and avoiding AEs.
METHODS: In a web-based discrete-choice experiment survey, respondents who self-reported having ≥ 6 migraine days/month were offered choices between pairs of hypothetical preventive migraine medicines. Six attributes, informed by clinician input and two focus groups, defined the medicines: efficacy (10%, 25%, or 50% reduction in migraine days/month), daily function (No Improvement, 1-Category Improvement, 2 Category Improvement on a 5-point scale), cognition problems (None, Thinking problems, Memory problems), weight gain (0%, 5%,10% bodyweight increase), mode of administration (Daily oral pill, 2 times/month injection, once/month injection), and monthly co-payment ($5, $60, $175). Random-parameters logit was used to estimate preference weights and the results used to calculate willingness to pay for attributes changes.
RESULTS: The sample was 300 respondents (average age 41 years, 67% female, 66% had private insurance, average number of migraine days/month of 15.7, 86% had taken a prescription medicine to prevent migraines, 72% reported that migraines made physical activities difficult “All/Most of the time”). Among non-cost attributes, respondents valued a change from a 10% reduction in migraine days to a 50% reduction more highly than avoiding the worst levels of AEs, but were willing to tradeoff efficacy for fewer AEs. Avoiding memory problems was more important than avoiding thinking problems. Avoiding a 10% weight gain was more important than avoiding cognition problems. Respondents preferred a one-a-month injection and daily pill to twice-a-month injection. Respondents were willing to pay up to $116 for reduction in migraine days up to 50%, and between $32 to $84 to avoid adverse events such as thinking problems, memory problems and a 10% weight again.
CONCLUSIONS: The unmet need with preventive treatment in migraine is extremely high as reflected in the high willingness to pay for a substantial reduction in migraine days and to avoid AEs. Respondents valued reduced migraine days, but were willing to tradeoff efficacy to avoid AEs associated with current medications. The results suggest a preventive medication with fewer AEs would be valuable to some migraine sufferers.
