Cost-Effectiveness of Oral Triptans for Acute Migraine: Mixed Treatment Comparison

Asseburg, Christian; Peura, Pekka; Oksanen, Tuija; Turunen, Juha; Purmonen, Timo; Martikainen, Janne

doi:10.1017/s0266462312000517

Cited by 9 publications

(21 citation statements)

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“…The relative efficacy of each triptan among each other is uncertain since the majority of triptan studies have been placebo controlled. Further, while other reviews have attempted to examine the relative efficacy of triptans among each other and vs non‐triptan migraine treatments, these studies have not considered multiple routes of administration (tablets, oral disintegrating tablets, injection, nasal spray, rectal suppositories), combination triptan therapy, or dose.…”

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Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta‐Analysis

et al. 2015

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Background.-Although triptans are widely used in the acute management of migraine, there is uncertainty around the comparative efficacy of triptans among each other and vs non-triptan migraine treatments. We conducted systematic reviews and network meta-analyses to compare the relative efficacy of triptans (alone or in combination with other drugs) for acute treatment of migraines compared with other triptan agents, non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid (ASA), acetaminophen, ergots, opioids, or anti-emetics.Methods.-The Cochrane Library, MEDLINE, and EMBASE were searched for randomized controlled trials that compared triptans (alone or in combination with other drugs) with placebo-controlled or active migraine treatments. Study selection, data extraction, and quality assessment were completed independently by multiple reviewers. Outcome data were combined and analyzed using a Bayesian network meta-analysis. For each outcome, odds ratios, relative risks, and absolute probability of response were calculated.Results.-A total of 133 randomized controlled trials met the inclusion criteria. Standard dose triptans relieved headaches within 2 hours in 42 to 76% of patients, and 2-hour sustained freedom from pain was achieved for 18 to 50% of patients. Standard dose triptans provided sustained headache relief at 24 hours in 29 to 50% of patients, and sustained freedom from pain in 18 to 33% of patients. Use of rescue medications ranged from 20 to 34%. For 2-hour headache relief, standard dose triptan achieved better outcomes (42 to 76% response) than ergots (38%); equal or better outcomes than NSAIDs, ASA, and acetaminophen (46 to 52%); and equal or slightly worse outcomes than combination therapy (62 to 80%). Among individual triptans, sumatriptan subcutaneous injection, rizatriptan ODT, zolmitriptan ODT, and eletriptan tablets were associated with the most favorable outcomes.

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Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta‐Analysis

et al. 2015

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

Section: What Is Reimbursement‐based Economics?mentioning

confidence: 99%

“…None of the studies used utility values that met Canadian guidelines for economic evaluation . Only 8 of the 21 studies were independent from industry funding …”

Section: What Is Reimbursement‐based Economics?mentioning

confidence: 99%

“…Two studies were assessed to be of suitable quality for informing reimbursement strategies . A report from the UK National Clinical Guideline Centre suggested that for naïve patients, triptans were more cost‐effective than acetaminophen, ergots, and non‐steroidal anti‐inflammatory drugs NSAIDs, and that for experienced patients, the addition of NSAIDs or acetaminophen to triptans dominated triptans alone .…”

Section: What Is Reimbursement‐based Economics?mentioning

confidence: 99%

“…A report from the UK National Clinical Guideline Centre suggested that for naïve patients, triptans were more cost‐effective than acetaminophen, ergots, and non‐steroidal anti‐inflammatory drugs NSAIDs, and that for experienced patients, the addition of NSAIDs or acetaminophen to triptans dominated triptans alone . The results from a Finnish Medicines Agency‐sponsored report imply that sumatriptan 100 mg dominated all other triptans with the exception of eletriptan 40 mg . Thus, the evidence from these 2 studies suggests that triptans are cost‐effective compared with ergots in the management of migraines.…”

Section: What Is Reimbursement‐based Economics?mentioning

confidence: 99%

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

et al. 2015

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Background.-In Ontario, approximately $3.8 billion is spent annually on publicly funded drug programs. The annual growth in Ontario Public Drug Program (OPDP) expenditure has been limited to 1.2% over the course of 3 years. Concurrently, the Ontario Drug Policy Research Network (ODPRN) was appointed to conduct drug class review research relating to formulary modernization within the OPDP. Drug class reviews by ODPRN incorporate a novel methodological technique called reimbursement-based economics, which focuses on reimbursement strategies and may be particularly relevant for policy-makers.Objectives.-To describe the reimbursement-based economics approach.Methods.-Reimbursement-based economics aims to identify the optimal reimbursement strategy for drug classes by incorporating a review of economic literature, comprehensive budget impact analyses, and consideration of cost-effectiveness. This 3-step approach is novel in its focus on the economic impact of alternate reimbursement strategies rather than individual therapies.Results.-The methods involved within the reimbursement-based approach are detailed. To facilitate the description, summary methods and findings from a recent application to formulary modernization with respect to the drug class tryptaminebased selective serotonin receptor agonists (triptans) used to treat migraine headaches are presented.Conclusions.-The application of reimbursement-based economics in drug policy reforms allows policy-makers to consider the cost-effectiveness and budget impact of different reimbursement strategies allowing consideration of the trade-off between potential cost savings vs increased access to cost-effective treatments.

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Public Health

Martelletti

2022

Migraine in Medicine

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Cost-Effectiveness of Oral Triptans for Acute Migraine: Mixed Treatment Comparison

Abstract: Depending on the decision-maker's willingness-to-pay threshold, either sumatriptan 100 mg or eletriptan 40 mg is likely to be cost-effective.

Cited by 9 publications

References 14 publications

Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta‐Analysis

Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta‐Analysis

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

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