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1.
J Manag Care Spec Pharm ; 26(11): 1456-1462, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33119447

RESUMO

DISCLOSURES: Funding for this summary was contributed by Arnold Ventures, California Health Care Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, America's Health Insurance Plans, Anthem, Allergan, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Boehringer-Ingelheim, Cambia Health Services, CVS, Editas, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, HealthFirst, Health Partners, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Pfizer, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, and United Healthcare. Agboola, Borrelli, Rind, and Pearson are employed by ICER. Touchette, through the University of Illinois at Chicago, received funding from ICER for development of the economic model described in this publication. Atlas has nothing to disclose.


Assuntos
Analgésicos/uso terapêutico , Peptídeo Relacionado com Gene de Calcitonina/antagonistas & inibidores , Transtornos de Enxaqueca/tratamento farmacológico , Receptores de Serotonina/efeitos dos fármacos , Agonistas do Receptor 5-HT1 de Serotonina/uso terapêutico , Analgésicos/efeitos adversos , Analgésicos/economia , Benzamidas/uso terapêutico , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Análise Custo-Benefício , Custos de Medicamentos , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/economia , Transtornos de Enxaqueca/metabolismo , Piperidinas/uso terapêutico , Piridinas/uso terapêutico , Pirróis/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Receptores de Serotonina/metabolismo , Agonistas do Receptor 5-HT1 de Serotonina/efeitos adversos , Agonistas do Receptor 5-HT1 de Serotonina/economia , Transdução de Sinais , Revisões Sistemáticas como Assunto , Fatores de Tempo , Resultado do Tratamento , Receptor 5-HT1F de Serotonina
2.
Headache ; 60(1): 190-199, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31889312

RESUMO

There are many new treatment options available for migraine and more are coming. Three calcitonin gene-related peptide (CGRP) antagonist monoclonal antibodies have been approved and a 4th is due in early 2020. Small molecule CGRP receptor-blocking oral compounds, both for acute care and prevention, are also coming. Four neurostimulators are available, with others on the way. New acute treatments coming soon include the 5HT1F agonist lasmiditan, a zolmitriptan intradermal micro-needle patch, and a nasal mist sumatriptan with a permeability enhancer. Farther out, three novel dihydroergotamine delivery systems, and a liquid-filled capsule of celecoxib show early promise. A new, safer form of methysergide is in the works, as is a longer-duration onabotulinumtoxinA. As always with new products, questions regarding safety, tolerability, cost, and insurance coverage will need to be addressed. Despite these concerns and uncertainties, a robust headache treatment pipeline is good for patients who are not satisfied with the results of their treatment and/or cannot tolerate existing treatments.


Assuntos
Analgésicos não Narcóticos/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Terapia por Estimulação Elétrica , Transtornos de Enxaqueca/terapia , Agonistas do Receptor 5-HT1 de Serotonina/uso terapêutico , Estimulação Magnética Transcraniana , Vasoconstritores/uso terapêutico , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Analgésicos não Narcóticos/economia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/economia , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/administração & dosagem , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/efeitos adversos , Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/economia , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Inibidores de Ciclo-Oxigenase 2/economia , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Agonistas do Receptor 5-HT1 de Serotonina/administração & dosagem , Agonistas do Receptor 5-HT1 de Serotonina/efeitos adversos , Agonistas do Receptor 5-HT1 de Serotonina/economia , Vasoconstritores/administração & dosagem , Vasoconstritores/efeitos adversos , Vasoconstritores/economia
3.
Value Health ; 22(3): 293-302, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832967

RESUMO

BACKGROUND: Migraine is a common, chronic, disabling headache disorder. Triptans, used as an acute treatment for migraine, are available via prescription in Australia. An Australian Therapeutic Goods Administration (TGA) committee rejected reclassifying sumatriptan and zolmitriptan from prescription medicine to pharmacist-only between 2005 and 2009, largely on the basis of concerns about patient risk. Nevertheless, pharmacist-only triptans may reduce migraine duration and free up healthcare resources. OBJECTIVES: To estimate the cost-effectiveness of reclassifying triptans from prescription-only to pharmacist-only in Australia. METHODS: The study design included decision-analytic modeling combining data from various sources. Behavior before and after reclassification was estimated using medical practitioner and patient surveys and also administrative data. Health outcomes included migraine frequency and duration as well as adverse events (AEs) discussed by the TGA committee. Efficacy and AEs were estimated using randomized controlled trials and observational studies. RESULTS: Reclassifying triptans will reduce migraine duration but increase AEs. This will result in 337 quality-adjusted life-years gained at an increased cost of A$5.9 million over 10 years for all Australian adults older than 15 years (19.6 million). The incremental cost-effectiveness ratio was estimated to be A$17 412/quality-adjusted life-year gained. CONCLUSIONS: The incremental cost-effectiveness ratio is likely to be considered cost-effective by Australian decision makers. Serotonin syndrome, a key concern of the TGA committee, had little impact on the results. Further research is needed regarding pharmacist-only triptan use by migraineurs currently using over-the-counter medicines and by nonmigraineurs, the efficacy of triptans, and the risk of cardiovascular and cerebrovascular AEs and chronic headaches with triptans.


Assuntos
Análise Custo-Benefício/métodos , Controle de Medicamentos e Entorpecentes/métodos , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/economia , Oxazolidinonas/classificação , Sumatriptana/classificação , Triptaminas/classificação , Austrália/epidemiologia , Análise Custo-Benefício/tendências , Controle de Medicamentos e Entorpecentes/economia , Clínicos Gerais/economia , Humanos , Transtornos de Enxaqueca/epidemiologia , Medicamentos sem Prescrição/classificação , Medicamentos sem Prescrição/economia , Medicamentos sem Prescrição/uso terapêutico , Oxazolidinonas/economia , Oxazolidinonas/uso terapêutico , Farmacêuticos/economia , Medicamentos sob Prescrição/classificação , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/uso terapêutico , Agonistas do Receptor 5-HT1 de Serotonina/classificação , Agonistas do Receptor 5-HT1 de Serotonina/economia , Agonistas do Receptor 5-HT1 de Serotonina/uso terapêutico , Sumatriptana/economia , Sumatriptana/uso terapêutico , Triptaminas/economia , Triptaminas/uso terapêutico
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