Pietzsch JB, Lund NL, Weber SA, Gaul C. Changes in medication cost observed in chronic cluster headache patients treated with sphenopalatine ganglion (SPG) stimulation: analysis based on 1-year data from the Pathway registry. Poster presentation to the World Congress of the International Neuromodulation Society, Edinburgh, 27 May–1 June 2017.

Objectives. Cluster headache is a severe primary headache disorder known to be highly disabling and associated with a significant economic burden. On-demand stimulation of the sphenopalatine ganglion (SPG) by means of an implantable neurostimulation system has been shown to be a safe and clinically promising therapy for treatment refractory cluster headache patients. Our objective was to estimate changes in cluster headache medication cost observed in chronic cluster headache patients treated with SPG stimulation, using baseline and 12-month utilization data from the recent Pathway R1 registry and German drug costs for reference.

Materials and Methods. Detailed patient-level data of n=71 chronic cluster headache patients treated with the ATI Pulsante Microstimulation System followed through 12 months in Pathway R1 (NCT01677026) were analyzed to assess weekly utilization of preventive, acute, and interventional cluster headache medications at baseline and 12 months. Cost estimates for all drug/dosage combinations were developed based on official German medication prices for 2016, and used the lowest priced product and largest available package size in each instance to determine cost. In addition to weekly costs, we studied the difference in annual medication cost between baseline and 12 month timepoints on the basis of a steady-state assumption and annualized costs obtained by multiplying weekly costs by 52 weeks per year.

Results. In the patients receiving SPG stimulation treatment, overall weekly medication costs were reduced by 54.8% from €283.35 to €128.11 (–€155.24) from baseline to 12 months. Relative savings were higher in acute medications than in preventive medications (55.3% vs. 42.5%). However, absolute savings were heavily driven by reductions in acute medication costs (€150.69 per week vs. €4.54 in preventive medications). Under the steady-state assumption, the observed drug cost reductions resulted in annualized total drug cost savings to payers of €8,072 (reduction from €14,734 to €6,662 per year).

Discussion. The results of our analysis confirm the significant cost burden associated with the treatment of cluster headache. They also provide real-world data on medication usage and associated costs in patients treated with SPG stimulation. On the basis of prior clinical studies investigating SPG therapy, these reductions stem from both effective treatment of attacks with stimulation, and also a reduction in attack frequency observed in stimulation-treated patients.

Conclusions. Our analysis suggests that SPG stimulation for the treatment of chronic cluster headache is associated with pronounced reductions in cluster headache medication usage that might lead to sizable annual savings in medication costs in the German healthcare system.