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[Economic evaluation of acute migraine attack treatment with triptans in Spain]

Author(s): Gracia-Naya M, Rejas Gutierrez J, Latorre Jimenez A, Gonzalez Garcia P

Affiliation(s): Servicio de Neurologia, Hospital Miguel Servet, Zaragoza, Spain.

Publication date & source: 2005-04, Neurologia., 20(3):121-32.

Publication type: Meta-Analysis

OBJECTIVE: To perform an economic evaluation of migraine attack treatment comparing standard doses of existing triptans in 2003, and using different outcome measurements of anti-migraine effectiveness. METHODS: A cost-effectiveness analysis was performed from the National Health System perspective, using 2003 prices, comparing almotriptan 12.5 mg, eletriptan 40 mg, naratriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 50 mg, sumatriptan 100 mg, zolmitriptan 2.5 mg and zolmitriptan 5 mg. Effectiveness measurements were obtained from an efficacy meta-analysis of published clinical trials, and they consisted of therapeutic gain (crude effect of triptan after placebo effect subtraction) for 2 h--anti-migraine response, pain free at 2 h, and 24 h--sustained pain free. Rescue medication use and 24 h-attack relapse rates were assessed. RESULTS: Thirty-eight clinical trials (19,872 patients) were used to assess triptans effectiveness. Eletriptan 40 mg and rizatriptan 10 mg showed the highest 24 h-sustained pain free response (20.2 % in both cases), pain-free at 2 h (27.7 % and 32.2 %) and antimigraine response at 2 h (38.6 % and 31.3 %), respectively. Less rescue medication was used with eletriptan 40 mg and sumatriptan 50 mg (21 % and 20 %), and the lowest 24 h-relapse rates were observed with eletriptan 40 mg and naratriptan 2.5 mg (27 % and 21 %). Eletriptan 40 mg and sumatriptan 50 mg showed the lowest costs per successfully treated attacks with 2 h--anti-migraine response (16.50 and 17.44e) and with 24 h--sustained pain free (31.47 and 33.61e), while the lowest costs per attack that was pain free at 2 h were observed with rizatriptan 10 mg (21.36e) and eletriptan 40 mg (22.99e). CONCLUSIONS: Considering the cost-effectiveness measurements assessed, eletriptan 40 mg was the most costeffective triptan in the majority of economic analyses carried out.

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