Journal of Medical Economics
Journal of Medical Economics |
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The clinical and financial impact of oral triptans in the management of migraine in the UK: a systematic review
Dr Jonathan Belsey MB BS1
1 JB Medical Ltd, The Old Brickworks, Chapel Lane, Little Cornard, Sudbury CO10 0PB, UK
Keywords: oral triptans, migraine, numbers needed to treat analysis, cost effectiveness, pain-free
Summary
The use of oral triptans for migraine accounts for more than �38 million of National Health Service expenditure every year. The majority of prescriptions are currently dispensed for the most costly triptan � sumatriptan. This paper presents a systematic review of both the clinical and cost effectiveness of all the oral triptans, in order to assess whether this is the most appropriate prescribing strategy.
Based on an NNT analysis of 19 randomised, controlled trials involving 7 675 patients' oral triptans, a clear hierarchy of clinical-effectiveness emerges. In terms of its ability to render patients pain-free within 2 hours, rizatriptan 10 mg (NNT = 3.1) is significantly more effective than sumatriptan 50 mg (NNT = 4.0; 2p = 0.01), sumatriptan 100 mg (NNT = 4.3; 2p<0.0001), zolmitriptan 2.5 mg (NNT = 5.9; 2p<0.0001) and naratriptan 2.5 mg (NNT = 9.2; 2p<0.0001). There was no significant difference between rizatriptan 10 mg and zolmitriptan 5 mg (NNT = 3.3; 2p<0.5) in this respect. There are, however, significant differences in the unit cost of the oral triptan, with NHS costs ranging from �4.00-�8.00 per dose. By applying these prices to the NNT values, cost effectiveness ratios were calculated for each of the agents in turn. Rizatriptan emerges as the most cost effective treatment, with a mean expenditure of £13.92 (95% CI: £12.89-£15.13) required to render one patient pain-free. This is significantly less than the costs associated with any of the other oral triptans: sumatriptan 50 mg (£19.54; 2p<0.001), zolmitriptan 2.5 mg (£23.66; 2p<0.0001), zolmitriptan 5 mg (£27.05; 2p<0.0001), sumatriptan 100 mg (£34.07; 2p<0.0001) and naratriptan 2.5 mg (£36.75; 2p<0.0001).