Cost Considerations of Acute Migraine Treatment

Adelman, James U.; Adelman, Leon C.; Freeman, Marshall C.; Seggern, Randal L. Von; Drake, Jaclyn

doi:10.1111/j.1526-4610.2004.04060.x

Cited by 17 publications

(17 citation statements)

References 85 publications

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“…For individuals with prescription drug copayments, triptan package size, itself, has become another important cost consideration. For instance, unit copayment may be less with triptans that contain nine tablets per blister pack, when compared with packs that contain fewer tablets 15 . Discerning the most cost‐effective packaging option can be a daunting task for the patient and clinician.…”

mentioning

confidence: 99%

Removing Barriers to Appropriate Migraine Treatment: Formulary Limitations and Triptan Package Size

Silberstein

Dodick²,

Kesslick³

2005

Headache

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The main goals in the pharmacologic management of migraine headache are to avert or relieve debilitating pain, prevent escalating acute medication use, and improve day-to-day functioning. This review will examine the evidence supporting the early use of acute medication, usually when pain is mild, to enhance patient outcomes. We will also discuss imposed quantity limits as a practical impediment to the implementation of this strategy in the managed care setting, and will identify strategies for overcoming this barrier to effective care. Quantity limits imposed on triptan therapy by health plans can hinder the optimal acute treatment of migraine. A standard triptan quantity limit sufficient to permit early migraine treatment and a movement by manufacturers to provide blister packs consistent with a standard quantity limit should reduce patients costs, permit brand mobility when appropriate, and bolster long-term cost effectiveness by removing an important impediment to the use of triptans when they are most effective, early in the migraine attack when pain is often still mild.

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confidence: 99%

Removing Barriers to Appropriate Migraine Treatment: Formulary Limitations and Triptan Package Size

Silberstein

Dodick²,

Kesslick³

2005

Headache

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“…6,7 Several treatment strategies can be implemented to enhance the value of migraine treatment including use of stratified care, early dosing, polypharmacy, pill splitting, use of rescue medication, and selection of medication package size. 8 Seven triptans are currently available in the United States, making it important for formulary committees, managed care organizations, and others to have sufficient information on the value of these therapeutic options to make informed decisions on optimal drug selection.…”

Section: Introductionmentioning

confidence: 99%

Using Patient-Centered Endpoints to Determine the Cost-Effectiveness of Triptans for Acute Migraine Therapy

Kelman¹,

Seggern

2006

American Journal of Therapeutics

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The objective of this study was to use the patient-centered efficacy measurements of sustained pain free and sustained pain free with no adverse events to compare the relative cost-effectiveness of 6 oral triptans in the treatment of acute migraine. Adverse event and sustained pain-free rates were obtained from a comprehensive meta-analysis of 53 clinical trials of oral triptans. Efficacy and tolerability were assumed to be independent. Average wholesale prices were in US dollars as of May 10, 2004. The meta-analysis of oral triptans reported that almotriptan 12.5 mg (Axert) exhibited the highest sustained pain-free rate (25.9%), with the lowest rate associated with eletriptan 20 mg (Relpax) (10.6%). In addition, almotriptan 12.5 mg possessed the lowest overall absolute adverse event rate (14.2%), with the highest adverse event rate exhibited by eletriptan 80 mg (53.9%). To attain 100 sustained pain-free patients, almotriptan 12.5 mg and rizatriptan 10 mg (Maxalt) proved to be the most cost-effective triptans, costing $7120 and $7427, respectively; the least cost-effective were naratriptan 2.5 mg (Amerge) ($13,736) and eletriptan 20 mg ($16,104). To attain 100 sustained pain-free with no adverse events patients, almotriptan 12.5 mg was the most cost-effective triptan ($8298) and the least cost-effective were eletriptan 20 mg ($25,521) and eletriptan 80 mg ($29,614). At average wholesale prices as of May 10, 2004, almotriptan 12.5 mg achieved the highest level of cost-effectiveness using either sustained pain free or sustained pain free with no adverse events as endpoints.

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“…Adelman [6] In conclusion, practitioners can optimise the use of healthcare dollars without compromising quality of care through awareness of cost-saving treatment strategies, as well as price variations among medications.…”

Section: Introductionmentioning

confidence: 99%

Risk–benefit and cost–benefit ratio in headache treatment

2005

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IntroductionHeadache disorders are ubiquitous, common, disabling and to a very large extent treatable in primary care. Migraine headaches affect 12% of the adult population worldwide and cause significant economic loss due to decreased workplace productivity. Although interactions between pharmacists and individuals with headache are common, few pharmacists receive adequate training regarding migraine therapy. There are several misconceptions that hinder effective care, such as that migraine is a vascular disease, triptans cause rampant cardiac-related morbidity and even mortality. The last decade's experience with triptans in more than half a billion people worldwide reveals a benign adverse-effect profile, particularly when taken early in an attack. Published reports and real-world experiences illustrate that these drugs do not merit fears of triptan-induced cardiac consequences in appropriately selected individuals. Society's productivity loss due to migraine is measured in billions of dollars. Restoring a patient's ability to function normally is now recognised as the primary treatment goal, not merely relieving pain. Thus, the over-reliance on "pain killer" drugs such as butalbital-containing products and the continued underutilisation of migraine-specific drugs need to be addressed [1]. Attack treatmentOne of the main problems in treating migraine is how to treat attacks. In this situation it has been shown that stratified care is more efficacious and economic than step care strategies [2]. These results were confirmed later and a J Headache Pain (2005) 6:315-318 DOI 10.1007/s10194-005-0219-5 Abstract The cost-benefit and the risk-benefit ratios are two of the most relevant items in ongoing health organisation procedures. The choice of a new or an old therapeutic treatment depends on a number of factors and the evaluation of the cost, in terms of economics, but also in terms of quality of life and type of facilities necessary for one treatment are crucial criteria. Therefore, we have to consider in evaluating treatment strategies not only the activity of a drug in reaching the main endpoints, (i.e., pain free or headache relief) but also the safety and perception of safety by patients, and the cost effectiveness, including indirect costs compared with personal and social benefits. Because it is reasonable that a subgroup of migraine patients may have a clinically progressive disorder, studies should be necessary to assess strategies for migraine treatments. Risk-benefit and cost-benefit ratio in headache treatment H E A D A C H E : T H E R A P E U T I C C H

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Cost Considerations of Acute Migraine Treatment

Abstract: Practitioners can optimize the use of health care dollars without compromising quality of care through awareness of cost-saving treatment strategies, as well as price variations among medications.

Cited by 17 publications

References 85 publications

Removing Barriers to Appropriate Migraine Treatment: Formulary Limitations and Triptan Package Size

Removing Barriers to Appropriate Migraine Treatment: Formulary Limitations and Triptan Package Size

Using Patient-Centered Endpoints to Determine the Cost-Effectiveness of Triptans for Acute Migraine Therapy

Risk–benefit and cost–benefit ratio in headache treatment

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