[Almotriptan vs. ergotamine plus caffeine for acute migraine treatment. A cost-efficacy analysis]. / Almotriptán frente a ergotamina más cafeína en el tratamiento de las crisis agudas de migraña. Análisis de coste-eficacia.

INTRODUCTION: Almotriptan has proven to be more efficacious and tolerable than ergotamine plus caffeine but is more expensive, thus raising the question about its cost-efficacy. METHODS: The course of migraine attacks during 24 hours treated with almotriptan and ergotamine plus caffeine was modelled with a decision tree, using efficacy data from a recent randomized, double-blind clinical trial comparing the two drugs. Costs were calculated from the social perspective (including indirect costs due to absenteeism and loss of productivity) and from the Spanish National Health System (NHS) perspective (only including drug costs). The impact on quality of life was estimated using utilities assigned in the literature to different health states of migraine patients. RESULTS: Treatment response was 57.7% for patients treated with almotriptan vs. 44.5% with ergotamine plus caffeine. Sustained pain-free status was achieved by 20.3% vs. 11.5%. Working days lost due to absenteeism and reduced productivity amounted to 0.24 vs. 0.38 days. Quality of life during attacks was estimated at an average utility of 0.548 vs. 0.422. From the NHS perspective, incremental costs per attack treated with almotriptan vs. ergotamine plus caffeine was euro 5.05, rendering an incremental cost-efficacy ratio of euro38.26 per additional response, euro57.39 per additional complete response, and euro14,709 per quality- adjusted life-year gained. From the social perspective almotriptan saved euro7.50 vs. ergotamine plus caffeine. CONCLUSIONS: Almotriptan can be considered cost-efficacious vs. ergotamine plus caffeine from the NHS perspective and is the dominant option (both more efficacious and more economical) from the social perspective.

Almotriptán frente a ergotaminamás cafeína en el tratamientode las crisis agudas de migraña. Análisis de coste-eficacia / Almotriptan vs. ergotamine plus caffeine for acute migraine treatment. A cost-efficacy analysis

Introducción. Almotriptán ha mostrado ser más eficaz y tolerableque ergotamina más cafeína, pero tiene un precio superior, por loque se plantea la pregunta de su coste-eficacia.Métodos. Se modeló mediante un árbol de decisión el curso durante24 h de ataques de migraña tratados con ambos fármacosusando datos de eficacia de un reciente ensayo clínico doble ciegoaleatorizado. Los costes fueron determinados desde las perspectivassocial y del sistema sanitario. El impacto sobre la calidad de vida seestimó a partir de índices asignados en la literatura a los diferentesestados de salud posibles en pacientes con migraña.Resultados. La respuesta al tratamiento fue del 57,7% con almotriptánfrente a 44,5% con ergotamina más cafeína; 20,3 frente a11,5% de pacientes alcanzaron ausencia mantenida de dolor durante24 h. Se perdieron 0,24 frente a 0,38 días laborales por absentismoy baja productividad. La calidad de vida durante el ataque sevaloró en una utilidad media de 0,548 frente a 0,422. Desde la perspectivadel sistema sanitario el diferencial de costes fue de 5,05 por ataque, resultando en un coste incremental de 38,26 por respuestaadicional conseguida con almotriptán, de 57,39 por respuestacompleta adicional y de 14.709 por año de vida ajustado por calidadganado. Desde la perspectiva social, almotriptán ahorró 7,50 por ataque en comparación con ergotamina más cafeína.Conclusiones. Almotriptán puede considerarse coste-eficazfrente a ergotamina más cafeína desde la perspectiva del sistema sanitarioy es la opción dominante (simultáneamente más eficaz y máseconómica) desde la perspectiva social (U)

Introduction. Almotriptan has proven to be more efficaciousand tolerable than ergotamine plus caffeine but is more expensive,thus raising the question about its cost-efficacy.Methods. The course of migraine attacks during 24 hours treatedwith almotriptan and ergotamine plus caffeine was modelledwith a decision tree, using efficacy data from a recent randomized,double-blind clinical trial comparing the two drugs. Costs werecalculated from the social perspective (including indirect costs dueto absenteeism and loss of productivity) and from the Spanish NationalHealth System (NHS) perspective (only including drug costs).The impact on quality of life was estimated using utilities assignedin the literature to different health states of migraine patients.Results. Treatment response was 57.7% for patients treatedwith almotriptan vs. 44.5% with ergotamine plus caffeine. Sustainedpain-free status was achieved by 20.3% vs. 11.5%. Workingdays lost due to absenteeism and reduced productivityamounted to 0.24 vs. 0.38 days. Quality of life during attackswas estimated at an average utility of 0.548 vs. 0.422. From theNHS perspective, incremental costs per attack treated with almotriptanvs. ergotamine plus caffeine was 5.05, rendering an incrementalcost-efficacy ratio of 38.26 per additional response, 57.39 per additional complete response, and 14,709 per quality-adjusted life-year gained. From the social perspective almotriptansaved 7.50 vs. ergotamine plus caffeineConclusions. Almotriptan can be considered cost-efficaciousvs. ergotamine plus caffeine from the NHS perspective and is thedominant option (both more efficacious and more economical)from the social perspective (AU)

Cost-effectiveness analysis of rizatriptan and sumatriptan versus Cafergot in the acute treatment of migraine.

BACKGROUND: Both ergotamine and selective serotonin 5-HT(1B/1D) receptor agonists ('triptans') are currently used in the treatment of moderate to severe migraine. Ergotamine is a traditional therapy with a lower drug acquisition cost compared with triptans. It has been shown that triptans are more efficacious than ergotamine, but the higher acquisition costs and shorter duration of action are disadvantages of triptans compared with ergotamine. OBJECTIVE: The purpose of this study was to provide a comparison of the cost-effectiveness of rizatriptan 10 mg and sumatriptan 50 mg tablets with that of a fixed-dose combination of ergotamine tartrate plus caffeine (Cafergot) in the treatment of an acute migraine attack. The cost-effectiveness of rizatriptan in comparison with sumatriptan was also assessed. METHODS: Three separate decision tree models were developed (model 1: rizatriptan vs Cafergot; model 2: sumatriptan vs Cafergot; model 3: rizatriptan vs sumatriptan). The time horizon was 1 year. Cost-effectiveness analysis was conducted from the societal perspective using cost and effectiveness estimates from the literature. All costs were converted to US dollars (2003). The cost-effectiveness ratio was expressed as incremental cost per quality-adjusted life-year (QALY) gained. RESULTS: Base case evaluation showed that both rizatriptan and sumatriptan dominated Cafergot. The net annual saving associated with use of rizatriptan was US dollars 622.98 per patient, with an incremental QALY of 0.001. Use of sumatriptan resulted in a saving of US dollars 620.90 and an increase in QALY. The cost-effective ratios were not sensitive to changes in key variables such as efficacy, utility, drug costs, hospitalisation cost and patient preference over alternative therapies. The study further showed that rizatriptan is more cost effective than sumatriptan, as evidenced by its lower cost and greater effectiveness. Sensitivity analysis showed that the cost-effectiveness ratios were sensitive to moderate changes in drug efficacy. CONCLUSION: Rizatriptan and sumatriptan were less costly and more effective than Cafergot in the treatment of an acute migraine attack. Rizatriptan was somewhat less costly and more effective than sumatriptan. Additional quality-of-life studies are needed to confirm the benefits of using triptans in the management of migraine.