Switching patients with migraine from sumatriptan to other triptans increases primary care costs

Abstract

Treatment of migraine with triptans is highly effective, although cost considerations may prompt a change in therapy. This retrospective database analysis of 3196 patients with migraine, established on sumatriptan therapy, found that 54% of the 292 experiencing a triptan switch returned to sumatriptan within 15 months, suggesting that the alternative was less acceptable. Excluding patients with unusually high use of triptans (> or = 208 tablets/year), switching therapy resulted in a significant increase of pounds sterling 53/patient in total costs, compared with patients continuing on sumatriptan (p = 0.014). Cost savings (pounds sterling 17/patient over 15 months) were observed only among the 41% of patients in whom the initial switch was successful and did not result in a further switch or return to sumatriptan. Among patients who were relatively low cost initially, switching resulted in increased costs, irrespective of the outcome. This study suggests that there is no economic justification for switching from sumatriptan to another triptan.

Actual Versus Projected Cost Avoidance for Clinical Pharmacy Specialist -Initiated Medication Conversions in a Primary Care Setting in an Integrated Health System

“…Long-term persistence rates for medication conversions for depression were not located in the published literature; however, reports on conversions involving medications used for chronic pain demonstrate similar persistence rates (41%-46%) to those reported in our analysis. 11,24 The persistence rates for medication conversions for hypertension (73%), and dyslipidemia (66%) in the present study are marginally lower than in other published reports (80%, and 88% for a CCB-to-CCB and CCB-to-CCB + diuretic combination conversions, respectively, and 78% for a statin conversion program), but the follow-up period for these studies was 3 to 6 months instead of 12 months. 13,14,25 Our somewhat lower persistence rates for these indications may have occurred because we (1) examined all conversions across pharmacologic classes, not just a single class; (2) converted outside of the pharmacologic class 45% of the time (e.g., conversion to a diuretic from a calcium channel blocker, conversion to a tricyclic antidepressant like amitriptyline from gabapentin, data not shown); and (3) converted formulary medications to formulary medications without a copayment incentive for patients.…”

Triptan persistency among newly initiated users in a pharmacy claims database

“…An Israeli health maintenance organization (HMO) study of 1498 patients receiving new triptan prescriptions found that 56% of patients purchased triptans only once during the 6-18 month follow-up period (13). Several pharmacy claims analyses conducted across Europe show similar results, with single-time triptan fill rates of 38%-56% (11,(14)(15)(16). The utilization and retention of triptans has been examined in managed care settings in the USA as well (17,18).…”

Assessment of Clinical, Service, and Cost Outcomes of a Conversion Program of Sumatriptan to Rizatriptan ODT in Primary Care Patients With Migraine Headaches

“…The medication conversions made by Savani et al were carried out in a general practitioner' s office and didn't necessarily include the same education and opportunity for direct telephone follow-up provided in our study. 21 We found important decreases in medication expenditures, using estimated representative group purchasing costs, for the subjects successfully converted to rizatriptan ODT that offset the small rise detected among conversion failure subjects. We expected no effect of this triptan conversion program on migraine-related office visit utilization or expenditures and found no evidence for a change in migraine-related office visit use or expenditures.…”

“…A similar conversion rate (41%) was reported by Savani et al in a conversion program for sumatriptan to other triptans. 21 However, Savani et al found that medication and health care cost savings were generated only among the subjects for whom the switch was successful, leading the authors to conclude that there was no economic justification for switching from sumatriptan to another triptan. 21 Our study differed in that our conversion program was carried out by clinical pharmacy specialists who, if desired, were available to …”

“…We followed subjects for 180 days after conversion initiation. A longer follow-up period may have provided different results since the above-mentioned large retrospective U.K. study 21 reviewed results of their triptan conversion project over a 15-month period. Nevertheless, we are confident that the outcomes in our investigation were assessed after a meaningful length of time.…”