A paper in the Journal of Headache and Pain reports that non-invasive stimulation of the vagus nerve (nVNS) is a cost effective therapy for cluster headache.  These findings were based on reductions in medication use and improvements in quality of life.  The publication also notes that further economic benefits would have been found had reduced visits to clinics been taken into account.

Cluster headache, which is considered one of the worst pain conditions known to medical science, has no approved therapies to prevent its attacks. The publication notes, “the treatment of cluster headache is challenging and many of the commonly used preventive medications are associated with serious safety risks, poor tolerability, and/or marginal efficacy.”

The findings in this publication follow from the successful PREVA trial, which involved 97 patients at ten sites across Europe. The patients were randomized into two arms – one using the gammaCore device plus the standard of care, and the other the standard of care alone. 40% of patients using gammaCore in addition to the standard of care had a ≥50% reduction in the number of weekly cluster headache attacks compared with 8% (p<0.001) in patients treated with the standard of care alone.  

The lead investigator of the PREVA trial, Dr. Charly Gaul, Head of the Migraine and Headache clinic Königstein, Germany stated, “It has been previously shown that gammaCore is an effective preventative against cluster attacks, but now we can see that it also reduces costs.”

In addition to the primary endpoint, i.e., reduction in attack frequency, the PREVA study also collected a variety of quality of life and economic measures, which permitted the modelling of cost-effectiveness reported on in this publication.  The current paper highlights a 25% reduction in costs associated with acute treatments such as zolmitriptan, sumatriptan and inhaled oxygen, which led to a savings in medication usage of approximately €1,736 per patient per year, and an average total cost savings of €2,799 per patient per year.  In all scenarios modelled, nVNS was more cost-effective than the current standard practice.

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