Cost savings in migraine associated with less chest pain on new triptan therapy.
OBJECTIVE
This article constructs an economic model to estimate cost of chest-pain-related care in migraine patients receiving almotriptan 12.5 mg compared with those receiving sumatriptan 50 mg.


METHODS
This population-based, retrospective cohort study used data from the MEDSTAT Marketscan database (Ann Arbor, Michigan) to quantify incidence and costs of chest-pain-related diagnoses and procedures. After a 6-month exclusion period, the study used a pre-post design, with baseline and treatment periods defined, respectively, as 5 months before and after receiving sumatriptan therapy. An economic model was constructed to estimate annual cost savings per 1,000 patients receiving almotriptan instead of sumatriptan as a function of differing rates of chest pain. Annual direct medical cost avoided was calculated for a hypothetical health plan covering 1 million lives.


RESULTS
Among a cohort of 1,390 patients, the incidence of chest-pain-related diagnoses increased significantly (43.6%) with sumatriptan, from 110 during the baseline period to 158 during the treatment period (P= .003). Aggregate costs for chest-pain-related diagnoses and procedures increased 33.1%, from $22,713 to $30,234. Payments for inpatient hospital services rose 10-fold; costs for primary care visits and outpatient hospital visits rose 53.1% and 14.4%, respectively. Payments for angiography increased from $0 to $462, and costs for chest radiographs and electrocardiograms increased 58.7% and 31.2%, respectively. Sumatriptan treatment was associated with a 3-fold increase in payments for services for painful respiration and other chest pain. The model predicted $11,215 in direct medical cost savings annually per 1000 patients treated with almotriptan instead of sumatriptan. Annual direct medical costs avoided for the health plan totaled $195,913.


CONCLUSIONS
Using almotriptan instead of sumatriptan will likely reduce the cost of chest-pain-related care for patients with migraine headaches.
Wang
Joseph T
JT
Pharmacia Corporation, Peapack, New Jersey, USA.
Barr
Charles E
CE
Torigoe
Yas
Y
Wang
Elaine
E
Rowland
Clayton R
CR
Goldfarb
Scott D
SD
D002637:Chest Pain / Q000139:chemically induced* / Q000191:economics; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003625:Data Collection; D005260:Female; D006801:Humans; D007211:Indoles / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy* / Q000191:economics*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D017366:Serotonin Receptor Agonists / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D018170:Sumatriptan / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D014363:Tryptamines; D014481:United States
D007211:Indoles; D017366:Serotonin Receptor Agonists; D014363:Tryptamines; C409045:almotriptan; D018170:Sumatriptan