An Economic Evaluation of Rizatriptan in the Treatment of Migraine
Background: Migraine is a common, chronic, neurovascular disorder, generally characterised by attacks of severe headache and autonomic nervous system dysfunction. Triptans are selective serotonin 5-HT1B/1D receptor agonists that represent effective therapeutic options for moderate-to-severe migraine attacks but with higher acquisition costs relative to usual care therapies. Objective: The objective of this study was to examine the cost effectiveness of rizatriptan treatment compared with `Usual Care' or other triptans available in Canada for patients with moderate-to-severe migraine for whom other therapies (e.g. NSAIDs, simple analgesics) are insufficient or contraindicated. Methods: A decision-analysis model was created to estimate migraine treatment costs over a 24-hour period in patients with a diagnosis of moderate-to-severe migraine as defined by the International Headache Society criteria. Costs and clinical outcomes were observed over a 24-hour period from therapy initiation. Efficacy measures consisted of `pain-free response at 2 hours' and `sustained pain free for 2-24 hours'. Oral rizatriptan 10mg was compared with other oral triptans (i.e. sumatriptan 50 or 100mg), naratriptan 2.5mg and zolmitriptan 2.5mg, based on a meta-analysis and compared with `Usual Care' based on a naturalistic study of people who experience migraine and who were similar to the target population. `Usual Care' was defined as an aggregate of medications prescribed for the Canadian population for the indication of migraine, weighted by the relative frequency of use of prescriptions over a 1-year period. Analyses were conducted from the Ontario (Canada) Ministry of Health and Long-Term Care (MOH<C) perspective and the broader societal perspective. Results are presented as the cost per migraine attack aborted (i.e. pain free at 2 hours), as well as the cost per QALY. Several one-way sensitivity analyses were conducted to test the robustness of the model. All costs are expressed in 2002 $Can. Results: Cost estimates are similar to previously published Canadian studies. Rizatriptan compared with `Usual Care' produced an incremental cost per attack aborted of $Can49.82 and a cost per QALY gained of $Can31_845 from the MOH<C perspective. When a societal perspective was considered (which included time loss from paid and unpaid work activities), rizatriptan dominates `Usual Care': that is, it is cost saving and more effective. All other triptans are also dominated by rizatriptan as they offer higher costs and lower efficacy. Conclusions: This study shows that rizatriptan treatment for patients who experience moderate-to-severe migraines may represent a cost-effective strategy for improving care of migraine patients in Canada.
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