Cost-Effectiveness of Migraine Prevention: The Case of Topiramate in the UK

Abstract

The aim of this study was to assess the cost-effectiveness of topiramate vs. no preventive treatment in the UK. Model inputs included baseline migraine frequency, treatment discontinuation and response, preventive and acute medical cost per attack [2005 GBP ( pound)] and gain in health utility. Outcomes included monthly migraines averted, acute and preventive treatment costs and cost per quality-adjusted life year (QALY). Topiramate was associated with 1.8 fewer monthly migraines and a QALY gain of 0.0384. The incremental cost of topiramate vs. no preventive treatment was about 10 UK pounds per migraine averted and 5700 UK pounds per QALY. Results are sensitive to baseline monthly migraine frequency, triptan use rate and the gain in utility. Incorporating savings from reduced work loss (about 36 UK pounds per month) suggests that topiramate would be cost saving compared with no preventive treatment. This analysis suggests that topiramate is a cost-effective treatment for migraine prevention compared with no preventive treatment.

The Effect of Migraine Prophylaxis on Migraine-Related Resource Use and Productivity

“…Migraine prophylaxis with topiramate has been shown to markedly improve patient QOL and work productivity, and reduce resource utilization. [6,[49][50][51][52] In two US claims database analyses with data for a total of 4394 patients with migraine, a statistically significant decrease in triptan use of up to 20% was noted in the 12-month period after starting topiramate therapy (table I). [50,52] Furthermore, in one of these analyses, [50] significant reductions were noted in the proportion of patients using concomitant non-opioid analgesics and NSAIDs during the 6 months after topiramate initiation.…”

“…[49] The topiramate-induced reduction in migraine frequency led to savings in acute treatment of d5.86 per patient per month. These savings in acute medical services would offset approximately onequarter of the monthly per patient cost (d24.19) of the preventive topiramate regimen, including treatment drop-outs and a mean of 1.5 monitoring visits per year.…”

“…Model inputs comprised baseline migraine attack frequency (with a base-case scenario of six attacks per month), treatment response and discontinuation rates, the cost of topiramate therapy plus physician visits for dosage titration, the costs of pharmacy and medical services per migraine, the number of disability hours per attack, hourly wage and utility (QOL) weighting. [6] In both models, topiramate prophylaxis was considered a cost-effective intervention in patients with migraine, [6,49] although cost effectiveness was dependent on a number of factors, including migraine frequency at baseline and a positive impact of migraine prevention on QOL.…”

“…The cost effectiveness and cost utility of topiramate migraine prophylaxis was assessed in two modelling studies using UK [49] and US [6] data (table II). Model inputs comprised baseline migraine attack frequency (with a base-case scenario of six attacks per month), treatment response and discontinuation rates, the cost of topiramate therapy plus physician visits for dosage titration, the costs of pharmacy and medical services per migraine, the number of disability hours per attack, hourly wage and utility (QOL) weighting.…”

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“…Topiramate and Gabapentin costs less than £4 (US $6) a week compared with at least £9 (US $14) for NRT [206,207].…”