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Cost-effectiveness of Triptan Therapies in Migraine

 

 
Cost-effectiveness of Triptan Therapies for Migraine
Vijay N. Joish, PhD and Diana I. Brixner, RPh, PhD

 

Five easy steps to ensure the most cost-effective benefits from a triptan:

  1. Treat early, but not too often
  2. Follow the treatment plan when you prove it works for you
  3. Limit caffeine or over-the-counter analgesics
  4. Be smart with your lifestyle choices
  5. Use preventive therapy  
Migraine affects as many as 18 percent of women and seven percent of men. This high incidence makes migraine a significant issue for employers, managed care organizations, and society as a whole. A typical U.S. company with 10,000 employees is projected to lose forty-six person-years of productivity annually as a result of migraine. According to a study by Hu and colleagues published in 1999, the economic burden of migraine in the United States totaled $13 billion and more recent estimates collected by Thomas Medstat reported an the economic cost of migraine to be as high as 24 billion US dollars annually.  
Triptans are a class of migraine-specific drugs taken at the start of an attack that act rapidly and cause minimal side effects. The triptans are:
  • Amerge® (naratriptan)
  • Axert® (almotriptan)
  • Frova® (frovatriptan)
  • Imitrex® (sumatriptan)
  • Maxalt® (rizatriptan)
  • Relpax® (eletriptan)
  • Treximet® (sumatriptan + naproxen sodium)
  • Zomig® (zolmitriptan)

    Not only are all triptans effective, but also they may be cost-effective. Triptans range in price from $12 US dollars per tablet to more than $50 for an injection. They seem expensive initially, but their expense may be offset by their ability to help people return to productivity or function more quickly. The disability that can be associated with a migraine attack can be costly, in both obvious and more subtle ways. Here are a few examples of how a more expensive medication may cut the cost of migraine.

 

  1. Miss less work
  2. Improve productivity when at work
  3. Lower need for extended child care or home help if headache goes away quickly
  4. Lower need for additional medications to treat persistent or recurrent attack
  5.  Lower need to go the emergency room if headache medication does not work efficiently
  6. Few side effects if only a single triptan dose is needed and redosing or treatment with rescue medication is given   
Relationship to real-life experience

Currently there are no well-designed clinical studies that specifically address if one triptan is more cost-effective than another. However, all triptans are effective and work through similar mechanisms in nervous system, therefore, using them appropriately will ensure the most likelihood of their cost effectiveness compared to other nontriptan therapies. There are several lifestyle factors that will ensure the triptan works optimally and that will increase the cost-effectiveness of treatment as a whole.

Five easy steps to ensure the most cost-effective benefits from a triptan:  

 

 
  1. Treat early: Studies show that early treatment of a migraine will improve the chances of the medication working best. Early means treating symptoms of an attack, such as pain, photophobia, or nausea, as soon as recognized as typical of migraine. Ideally treatment is when pain is mild and within 15-60 minutes of onset depending on the typical time to disability.
  2. Follow the treatment plan when it works for you: Medications are prescribed to ensure optimal success; however, if the medications are not taken appropriately, they may be more harmful then helpful. If the treatment plan doesn’t consistently work, then a new plan is needed. For example, if your practitioner tells you to take a triptan and for your really bad headaches, add naproxen sodium, then it is important that naproxen sodium be used as directed and has added benefit. Daily analgesic use without detailed reason for this may actually be harmful to your headache condition.
  3. Limit caffeine or over-the-counter analgesics: Caffeine and most over-the-counter analgesics, if taken in excess, may trigger migraine. Excess is typically 9 to 15 days on average per month. If any acute medication is used on average 2 days a week, with the possible exception of the menstrual period week, a reduction in headache frequency is desirable or progression of headaches is a severe risk. Typically the headaches will continue and possibly increase until caffeine consumption is reduced or eliminated and the over-the-counter analgesic medications are used less than 9 to 15 days per month. While taking a triptan to treat these headaches may work for a short-term fix, they too can be overused and must be restricted to the same frequency of use as other analgesics.
  4. Be smart with your lifestyle choices: Some lifestyle factors may make headaches worse. For example, when dieting, extended periods of fasting may trigger migraine. Another example is too much exercise may cause dehydration and fatigue, which also may trigger attacks. Therefore, make good lifestyle choices that will promote the chances of the treatment plan being effective.
  5. Use preventive therapy: The American Migraine Prevalence and Prevention workgroup recommends a preventive medication for 4-5 non-disabling attacks or 2 or more disabling attacks per month. In addition, the use of behavioral headache medicine techniques combined with a daily medication will reduce the frequency of headaches further. A headache preventive therapy goal is to reduce attacks by 50% or more. By adding another medication, which may be expensive but does not have to be, the use of triptans and other acute medications should be decreased by reducing the frequency of attacks.  
The Future of Headache Cost Evaluations
 
As healthcare costs continue to rise, there will be increased scrutiny over the true “value” of new medications for patients. Cost comparisons between individual drugs based solely on ingredient cost are no longer valid. Instead, doctors, patients, and insurance companies should consider the total cost consequence of individual therapies. Effective migraine care requires designing a successful treatment plan which includes tracking and using medication appropriately while modifying lifestyles and behaviors.

—Vijay N. Joish, PhD, Research Assistant Professor, and Diana I. Brixner, RPh, PhD, Associate Professor and Chair, Department of Pharmacotherapy, College of Pharmacy, Pharmacotherapy Outcomes Research Center, University of Utah. Salt Lake City, UT

Updated June 2008 from Headache, the Newsletter of ACHE, Spring 2005, Volume 16, Issue 1.

 
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