A literature review comparing the economic, clinical, and humanistic attributes of dihydroergotamine and sumatriptan.
The value of different pharmaceuticals in treating migraine is frequently based on clinical efficacy only. This article assumes a broader perspective and compares the clinical, economic, and humanistic attributes of two antimigraine medications, dihydroergotamine (DHE) and sumatriptan, based on a literature review. DHE is an established product with over 40 years of use in the treatment of migraine. Sumatriptan is a new product with a higher acquisition cost than DHE. Because sumatriptan costs more than DHE, the question must be asked. "Does sumatriptan provide advantages that offset this price differential?" This question reflects the growing concern among payers and patients over the cost and effectiveness of therapies. However, it is not easily answered. Direct comparative data are not available, and data sources are different for the two products. Moreover, the products are currently marketed in different dosage forms--intramuscular for DHE and subcutaneous for sumatriptan. The literature reviewed indicates that the clinical attributes of the two products are similar, with each having slightly different advantages and disadvantages. However, the DHE literature is generally limited to uncontrolled studies, whereas the sumatriptan literature reports the results of rigorously designed, randomized, double-blind, placebo-controlled clinical trials. Published data on the products' economic and humanistic attributes are limited. We concluded that the literature does provide important, albeit limited, data on the economic, clinical, and humanistic attributes of DHE and sumatriptan that permit restricted comparisons. The limitations of the data highlight the need for comparative studies of these products' multidimensional attributes both in controlled clinical trials and under actual practice conditions.
Kozma
C M
CM
University of South Carolina, College of Pharmacy, Columbia 29208.
Mauch
R P
RP
Reeder
C E
CE
Lawrence
B J
BJ
D002986:Clinical Trials as Topic; D004087:Dihydroergotamine / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*; D011788:Quality of Life; D012196:Review Literature as Topic; D018170:Sumatriptan / Q000191:economics / Q000627:therapeutic use*
D004087:Dihydroergotamine; D018170:Sumatriptan