Rizatriptan: A Pharmacoeconomic Review of its Use in the Acute Treatment of Migraine
Paul L. McCormack
Rachel H. Foster
Rizatriptan (Maxalt(R); Maxalt-MLT(R); Maxalt-Melt(R)) is an oral serotonin 5-HT1B/1D receptor agonist (triptan) used in the acute treatment of migraine with or without aura in adults. Rizatriptan 5mg and 10mg are effective in relieving the symptoms of migraine and the 10mg dose provided faster pain relief than sumatriptan 50mg, naratriptan 2.5mg, ergotamine/caffeine 2mg/200mg and possibly zolmitriptan 2.5mg, while displaying similar tolerability. Two cost-utility analyses performed from a societal perspective indicated that rizatriptan 10mg was dominant over ergotamine/caffeine 2mg/200mg, sumatriptan 50mg or 100mg, naratriptan 2.5mg, zolmitriptan 2.5mg and analgesic-based usual care in the acute treatment of migraine. In one analysis also performed from the perspective of a healthcare payer, rizatriptan was still dominant over naratriptan, sumatriptan and zolmitriptan. Rizatriptan was cost effective compared with usual care with an incremental cost per quality-adjusted life-year (QALY) gained of $Can31_845 (2002 values) and an incremental cost per additional attack aborted of $Can49.82. A modelled cost-effectiveness analysis conducted from a healthcare payer's perspective indicated that almotriptan 12.5mg was more cost effective than rizatriptan 10mg as a result of better tolerability. The incremental cost per additional successfully treated patient (defined as being sustained pain free without adverse events) with almotriptan was $US6.94 (1999 values). In other nonmodelled cost-effectiveness analyses, rizatriptan 10mg, eletriptan 40mg and almotriptan 12.5mg most consistently displayed the greatest cost effectiveness in different analyses using different clinical endpoints. A modelled analysis of the costs of migraine-related productivity losses in US corporations indicated that the use of rizatriptan rather than usual care to treat migraines could result in annual cost offsets of approximately $US84-118 (2000 values) per employee in lost productivity avoided. An intervention study in Spanish postal service workers demonstrated that replacement of usual care with rizatriptan reduced the mean per-patient cost of lost productivity per migraine attack from _34.47 (2001/2002 values) before the intervention to _13.94 and _4.59 for the first and second post-intervention migraine attacks. In conclusion, rizatriptan is one of the more clinically effective and therefore cost-effective oral triptans available for the acute treatment of migraine. The available data from cost-utility analyses suggest that rizatriptan is more cost effective than ergotamine/caffeine, simple analgesics, naratriptan, zolmitriptan and sumatriptan. The economic value of rizatriptan depends on the payer's perspective, as the greatest savings can be expected to be achieved in terms of reduced migraine-related loss of work productivity compared with less effective treatments. For healthcare payers, the high acquisition cost appears to be at least partly offset by reduced migraine-related healthcare resource use when compared with usual care. The comparative cost effectiveness of the newer triptans requires further elucidation from comprehensive direct comparisons.
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