Table 41:
Variables Varied in Scenario Analyses: Cluster Headache and Migraine
| Scenario | Model applicability | Reference case | Scenario analysis |
|---|---|---|---|
| 1: Cost of the nVNS device | Cluster headache and migraine | $6,376 CAD/y | ± 25% ($1,594) cost variation |
| 2: Societal perspective | Cluster headache and migraine | Ministry of Health perspective | Including health care-related out-of-pocket expenses for patients, as well as costs of productivity loss |
| 3: nVNS provided free for the first 93 days | Cluster headache and migraine | No free trial | Free trial for the first 93 d |
| 4: Change in the clinical pathway | Cluster headache and migraine | Assume that neurologists or headache specialists prescribe nVNS and guide patient care | Assume general practitioners prescribe nVNS and guide patient care |
| 5: Change in time horizon | Cluster headache and migraine | 1 y | 6 mo and 2 y |
| 6: Changes in quality of life in the nVNS arm for people with cluster headache | Cluster headache | Patients experience 100% constant utility benefits throughout the model time horizon | Beyond 12 wk, utility benefits decrease to 75% |
| 7: Response-dependent treatment continuation beyond 3 mo | Cluster headache and migraine | Patients continue to use nVNS after the trial period and experience the same average effects as observed in the clinical trials | Nonresponders stop receiving nVNS after 3 mo, and the costs and effectiveness are assumed to be the same between arms beyond 3 mo |
| 8: Reduction in acute medication use in people with cluster headache | Cluster headache | 61% reduction in the use of subcutaneous sumatriptan injections with nVNS | 0% reduction in the use of acute medication with nVNS and standard care |
| 9: Nasal sumatriptan spray to replace sumatriptan injections in people with cluster headache | Cluster headache | Sumatriptan injections used for acute treatment of cluster headache | Nasal sumatriptan spray replaces sumatriptan injection |
| 10: Publicly available Canadian costs for nVNS device used | Cluster headache and migraine | Using manufacturer-provided costs for nVNS device used | $650 initial 93 d prescription, $650 subsequent 93 d prescriptions109 |
All costs expressed in 2023 CAD.
Abbreviations: nVNS, noninvasive vagus nerve stimulation.