A pharmacoeconomic evaluation of oral triptans in the treatment of migraine in Italy.
OBJECTIVE
The goal of this economic evaluation was to compare the cost-efficacy of oral triptans currently used in the treatment of migraine in Italy.


METHODS
The cost analysis of drugs was conducted through a structured decision tree, built up taking into account the National Healthcare System perspective. Data on the clinical efficacy and tolerability of oral triptans were derived from a published meta-analysis of 53 randomized, controlled trials. Drug cost-allocation included either the oral triptans price and costs related to management of treatment-associated chest and central nervous system (CNS) adverse events. Necessary resources for management of the unwanted events were identified by asking an experienced panel of experts how they would treat patients with triptan-related chest and CNS adverse events. To further improve the economic scenario and to allow a broader inference of pharmacoeconomic analysis, the number needed to treat (NNT) to attain 100 sustained pain free (SPF) patients, and 100 patients with SPF and no adverse events (SNAE) were also calculated.


RESULTS
Study results show cost-effective differences among oral triptans. The best cost-efficacy ratios were attained by almotriptan 12.5 mg and rizatriptan 5 mg, with 18.47 Euro and 26.37 Euro respectively per patient successfully treated (SPF). Similarly, the NNT analysis favoured almotriptan, which requires 386 patients to attain 100 SPF patients, and 393 patients to attain 100 SNAE patients. Rizatriptan 10 mg resulted the closest competitor, requiring 395 and 457 patients, respectively.


CONCLUSIONS
On the basis of published data and within the limitations of this model analysis that included several assumptions, results suggest the economical advantage of almotriptan 12.5 mg among the oral triptans approved for the treatment of migraine in Italy. This evidence could drive selection of the most appropriate oral treatment for acute migraine attacks based on both individual patient's needs and cost-effective drugs.
Gori
S
S
Unit of Neurology, Department of Neuroscience, University of Pisa, Pisa, Italy. s.gori@med.unipi.it
Morelli
N
N
Acuto
G
G
Caiola
F
F
Iudice
A
A
Murri
L
L
D000284:Administration, Oral; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D007558:Italy; D008881:Migraine Disorders / Q000188:drug therapy* / Q000191:economics; D012680:Sensitivity and Specificity; D014230:Triazoles / Q000627:therapeutic use; D014363:Tryptamines / Q000191:economics / Q000627:therapeutic use*
D014230:Triazoles; D014363:Tryptamines; C409045:almotriptan; C093622:rizatriptan