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

Abstract

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.

A review of the pharmacoeconomics of eletriptan for the acute treatment of migraine

“…Kelman and Von Seggern 34 conducted a cost-effectiveness analysis of triptans, using the efficacy and tolerability data from the published meta-analysis, 30 using sumatriptan 100 mg as the comparator. A successful outcome measure was described in terms of sustained pain-free plus no adverse events (SNAE).…”

“…This pharmacoeconomic study found that when using average wholesale prices, almotriptan 12.5 mg ($7,120), rizatriptan 10 mg ($7,427), followed by eletriptan 40 mg ($8,167) were the most cost-effective treatment options ( Table 4 ). 34 A potential limitation of this study was that the calculation of SNAE was based on the assumption that efficacy and tolerability are uncorrelated. 34 However, the actual association between efficacy and tolerability of triptans is unknown.…”

Reimbursement‐Based Economics – What Is It and How Can We Use It to Inform Drug Policy Reform?

“…Of the 72 economic citations retrieved for detailed review, 21 publications addressed the objective of the review and were selected for inclusion (Fig. ) …”

“…All of these studies were published between 1995 and 2002 and therefore were based on dated information and included drug costs prior to the availability of generic formulations. Nine out of the 21 studies considered outcomes that would be considered inappropriate for making funding recommendations within the context of economic evaluation …”

“…Eleven out of 21 studies used effectiveness data, which had previously been considered of low quality by the Canadian Agency for Drugs and Technology in Health . None of the studies used utility values that met Canadian guidelines for economic evaluation .…”