Cost-efficacy of oral triptans in the treatment of acute migraine

The objective of this study was to compare the efficiency of oral triptans currently used in the treatment of acute migraine in Spain. Using a decision analytic model, a cost-efficacy analysis was performed from the payer's perspective. Efficacy was assessed in terms of sustained pain-free patients, with data extracted from a recent metaanalysis of clinical trials. Chest-related and central nervous system-related adverse events were also considered. For the economic analysis, the cost of drug treatment and the management of adverse events were determined. A group of three triptans (naratriptan 2.5 mg, sumatriptan 50 mg and almotriptan 12.5 mg) was found to dominate all other triptans in the sense that the other triptans were more expensive but did not show higher efficacy. Naratriptan 2.5 mg offered the lowest cost of the three, while almotriptan 12.5 mg showed the highest level of efficacy. The incremental cost-efficacy ratio for sumatriptan 50 mg versus naratriptan 2.5 mg was €23.09 per sustained pain-free patient. The incremental cost-efficacy ratio for almotriptan 12.5 mg versus sumatriptan 50 mg was €10.45 per sustained pain-free patient. However, 95% confidence intervals for efficacy and costs of almotriptan 12.5 mg overlapped with those of rizatriptan 10 mg, while 95% confidence intervals of sumatriptan 50 mg overlapped with those of naratriptan 2.5 mg, zolmitriptan 2.5 mg and eletriptan 40 mg. A third cluster of triptans with overlapping confidence intervals, showing higher costs but not higher efficacy than almotriptan 12.5 mg and rizatriptan 10 mg, included sumatriptan 100 mg, zolmitriptan 5 mg and eletriptan 80 mg. It is concluded that, combining clinical and economic considerations, rizatriptan 10 mg and, particularly, almotriptan 12.5 mg are the most appealing triptans in Spain. © 2005 T&F Informa UK Ltd.