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01-08-2010 | Original Research Article

Cost Effectiveness of Pharmacotherapy for the Prevention of Migraine

A Markov Model Application

Authors: Junhua Yu, Kenneth J. Smith, Dr Diana I. Brixner

Published in: CNS Drugs | Issue 8/2010

Abstract

Background: There are few data about the cost effectiveness of prophylactic medications for migraine. Clinical trials have shown several preventive agents to be useful in reducing the frequency of migraine attack while having tolerable side effects.

Objective: To compare the cost effectiveness of adding preventive treatment to abortive therapy for acute migraine with abortive therapy for acute migraine alone in the primary care setting.

Methods: A Markov decision analytic model with a cycle length of 1 day, a time horizon of 365 days and three health states was used to perform an analysis comparing the cost effectiveness and utility of five treatments for migraine prophylaxis (amitriptyline 75 mg/day, topiramate 100 and 200 mg/day, timolol 20 mg/day, divalproex sodium 1000 mg/day or propranolol 160 mg/day) with treatment of acute migraine alone for the management of migraine in the primary care setting. One-way and probabilistic sensitivity analyses were performed to test the robustness of the results.

Results: The expected total annual cost for the use of preventive agents ranged from $US2932 to $US3887, compared with $US3960 for the use of abortive medications only. In the baseline analysis, use of each of the five preventive agents generated more quality-adjusted life-years (QALYs) and incurred lower costs compared with abortive medications only. Monte Carlo Simulation suggested that amitriptyline 75 mg/day was most likely to be considered a cost-effective option versus the other five therapies, followed by timolol 20 mg/day, topiramate 200 mg/day, topiramate 100 mg/day, divalproex sodium 1000 mg/day and propranolol 160 mg/day when the willingness-to-pay (WTP) for society is <$US18 000 per QALY gained.

Conclusions: Preventive medications appear to be a cost-effective approach to the management of migraine in the primary care setting compared with the approach of abortive treatment only. Among those preventive agents, probabilistic sensitivity analysis suggests that, when the societal WTP is <$US18 000 per QALY gained, amitriptyline 75mg/day is most likely to be considered a cost-effective option.

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Morey V, Rothrock JF. Examining the utility of in-clinic “rescue” therapy for acute migraine. Headache 2008; 48(6): 939–43PubMedCrossRef

Lipton RB, Diamond S, Reed M, et al. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001; 41(7): 646–57PubMedCrossRef

Brown JS, Papadopoulos G, Neumann PJ, et al. Cost-effectiveness of topiramate in migraine prevention: results from a pharmacoeconomic model of topiramate treatment. Headache 2005; 45(8): 1012–22PubMedCrossRef

Adelman JU, Adelman LC, von Seggern R. Cost-effectiveness of antiepileptic drugs in migraine prophylaxis. Headache 2002; 42(10): 978–83PubMedCrossRef

Farmer K, Cady R, Bleiberg J, et al. Sumatriptan nasal spray and cognitive function during migraine: results of an open-label study. Headache 2001; 41(4): 377–84PubMedCrossRef

Rapoport AM. Pharmacological prevention of migraine. Clin Neurosci 1998; 5(1): 55–9PubMed

Bland S. Migraine prophylaxis. J Pharm Soc Wis 2000 Nov/Dec; 20-4

Demaagd G. The pharmacological management of migraine: part 2. Preventive therapy [online]. PT 2008; 33(8): 480–7. Available from URL: http://www.ptcommunity.com/ptjournal/fulltext/33/8/PTJ3308480.pdf [Accessed 2010 Feb 23]

Ramadan NM, Silberstein SD, Freitag FG, et al. Evidence-based guidelines for migraine headache in the primary care setting: pharmacological management for prevention of migraine [online]. Available from URL: http://www.aan.com/professionals/practice/pdfs/gl0090.pdf [Accessed 2010 Apr 26]

10.

Silberstein SD, Goadsby PJ. Migraine: preventive treatment. Cephalalgia 2002; 22(7): 491–512PubMedCrossRef

11.

Cole JC, Lin P, Rupnow MF. Validation of the Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ v. 2.1) for patients undergoing prophylactic migraine treatment. Qual Life Res 2007; 16(7): 1231–7CrossRef

12.

Rapoport A, Bigal M. Migraine preventive therapy: current and emerging treatment options. Neurol Sci 2005; 26: 111–20CrossRef

13.

Ramadan NM. Current trends in migraine prophylaxis. Headache 2007; 47 Suppl. 1: S52–7PubMedCrossRef

14.

Soto J. Health economic evaluations using decision analytic modeling: principles and practices: utilization of a checklist to their development and appraisal. Int J Technol Assess Health Care 2002; 18(1): 94–111PubMed

15.

Perfetto EM, Weis KA, Mullins CD, et al. An economic evaluation of triptan products for migraine. Value Health 2005; 8(6): 647–55PubMedCrossRef

16.

Zhang L, Hay JW. Cost-effectiveness analysis of rizatriptan and sumatriptan versus cafergot in the acute treatment of migraine. CNS Drugs 2005; 19(7): 635–42PubMedCrossRef

17.

Price MJ, Briggs AH. Development of an economic model to assess the cost effectiveness of asthma management strategies. Pharmacoeconomics 2002; 20(3): 183–94PubMedCrossRef

18.

19.

Ferrari MD, Goadsby PJ, Roon KI, et al. Triptans (serotonin, 5-HT1B/1D agonists) in migraine: detailed results and methods of a meta-analysis of 53 trials. Cephalalgia 2002; 22(8): 633–58PubMedCrossRef

20.

Ferrari MD, Roon KI, Lipton RB, et al. Oral triptans (serotonin 5-HT(1B/1D) agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 2001; 358(9294): 1668–75PubMedCrossRef

21.

Dodick DW, Sandrini G, Williams P. Use of the sustained pain-free plus no adverse events endpoint in clinical trials of triptans in acute migraine. CNS Drugs 2007; 21(1): 73–82PubMedCrossRef

22.

Hu XH, Markson LE, Lipton RB, et al. Burden of migraine in the United States: disability and economic costs. Arch Intern Med 1999; 159(8): 813–8PubMedCrossRef

23.

Brown JS, Neumann PJ, Papadopoulos G, et al. Migraine frequency and health utilities: findings from a multisite survey. Value Health 2008; 11(2): 315–21PubMedCrossRef

24.

Brandes JL, Saper JR, Diamond M, et al. Topiramate for migraine prevention: a randomized controlled trial. JAMA 2004; 291(8): 965–73PubMedCrossRef

25.

Briggs A, Sculpher M. An introduction to Markov modelling for economic evaluation. Pharmacoeconomics 1998; 13(4): 397–409PubMedCrossRef

26.

Maizels M, Houle T. Results of screening with the brief headache screen compared with a modified IDMigraine. Headache 2008; 48(3): 385–94PubMedCrossRef

27.

Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology 2007; 68(5): 343–9PubMedCrossRef

28.

Ferrari MD. The economic burden of migraine to society. Pharmacoeconomics 1998; 13(6): 667–76PubMedCrossRef

29.

Gallagher RM, Kunkel R. Migraine medication attributes important for patient compliance: concerns about side effects may delay treatment. Headache 2003; 43(1): 36–43PubMedCrossRef

30.

Lipton RB, Diamond S, Reed M, et al. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache 2001; 41(7): 638–45PubMedCrossRef

31.

Stewart WF, Lipton RB. Prevalence of migraine headache in the United States [abstract]. JAMA 1992; 267(1): 64PubMedCrossRef

32.

Mathew NT. The prophylactic treatment of chronic daily headache. Headache 2006; 46(10): 1552–64PubMedCrossRef

33.

Linde K, Rossnagel K. Propranolol for migraine prophylaxis. Cochrane Database Syst Rev 2004; (2): CD003225

34.

Tfelt-Hansen P, Block G, Dahlöf C, et al. Guidelines for controlled trials of drugs in migraine: second edition. Cephalalgia 2000; 20(9): 765–86PubMedCrossRef

35.

Diener HC, Matias-Guiu J, Hartung E, et al. Efficacy and tolerability in migraine prophylaxis of flunarizine in reduced doses: a comparison with propranolol 160 mg daily. Cephalalgia 2002; 22(3): 209–21PubMedCrossRef

36.

Diener HC, Bussone G, Van Oene JC, et al. Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 2007; 27(7): 814–23PubMedCrossRef

37.

Silberstein SD, Neto W, Schmitt J, et al. Topiramate in migraine prevention: results of a large controlled trial. Arch Neurol 2004; 61(4): 490–5PubMedCrossRef

38.

Keskinbora K, Aydinli I. A double-blind randomized controlled trial of topiramate and amitriptyline either alone or in combination for the prevention of migraine. Clin Neurol Neurosurg 2008; 110(10): 979–84PubMedCrossRef

39.

Peres MF, Silberstein S, Moreira F, et al. Patients’ preference for migraine preventive therapy. Headache 2007; 47(4): 540–5PubMedCrossRef

40.

Bulut S, Berilgen MS, Baran A, et al. Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study. Clin Neurol Neurosurg 2004; 107(1): 44–8PubMedCrossRef

41.

Bendtsen L, Jensen R, Olesen J. Amitriptyline, a combined serotonin and noradrenaline re-uptake inhibitor, reduces exteroceptive suppression of temporal muscle activity in patients with chronic tension-type headache. Electro-encephalogr Clin Neurophysiol 1996; 101(5): 418–22

42.

43.

Carroll JD, Reidy M, Savundra PA, et al. Long-acting propranolol in the prophylaxis of migraine: a comparative study of two doses. Cephalalgia 1990; 10(2): 101–5PubMedCrossRef

44.

Diener HC, Tfelt-Hansen P, Dahlof C, et al. Topiramate in migraine prophylaxis: results from a placebo-controlled trial with propranolol as an active control. J Neurol 2004; 251(8): 943–50PubMedCrossRef

45.

Tfelt-Hansen P, Standnes B, Kangasneimi P, et al. Timolol versus propranolol versus placebo in common migraine prophylaxis: a double-blind multicenter trial. Acta Neurol Scand 1984; 69(1): 1–8PubMedCrossRef

46.

Pradalier A, Serratrice G, Collard M, et al. Long-acting propranolol in migraine prophylaxis: results of a double-blind, placebo-controlled study. Cephalalgia 1989; 9(4): 247–53PubMed

47.

Stellar S, Ahrens SP, Meibohm AR, et al. Migraine prevention with timolol: a double-blind crossover study. JAMA 1984; 252(18): 2576–80PubMedCrossRef

48.

Freitag FG, Collins SD, Carlson HA, et al. A randomized trial of divalproex sodium extended-release tablets in migraine prophylaxis. Neurology 2002; 58(11): 1652–9PubMedCrossRef

49.

Klapper J. Divalproex sodium in migraine prophylaxis: a dose-controlled study. Cephalalgia 1997; 17(2): 103–8PubMedCrossRef

50.

Dodick DW, Freitag F, Banks J, et al. Topiramate versus amitriptyline in migraine prevention: a 26-week, multi-center, randomized, double-blind, double-dummy, parallel-group noninferiority trial in adult migraineurs. Clin Ther 2009; 31(3): 542–59PubMedCrossRef

51.

Storey JR, Calder CS, Hart DE, et al. Topiramate in migraine prevention: a double-blind, placebo-controlled study. Headache 2001; 41(10): 968–75PubMedCrossRef

52.

Millan-Guerrero RO, Isais-Millan R, Barreto-Vizcaino S, et al. Subcutaneous histamine versus topiramate in migraine prophylaxis: a double-blind study. Eur Neurol 2008; 59(5): 237–42PubMedCrossRef

Title: Cost Effectiveness of Pharmacotherapy for the Prevention of Migraine
A Markov Model Application
Authors: Junhua Yu
Kenneth J. Smith
Dr Diana I. Brixner
Publication date: 01-08-2010
Publisher: Springer International Publishing
Published in: CNS Drugs / Issue 8/2010
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI: https://doi.org/10.2165/11531180-000000000-00000

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cost Effectiveness of Pharmacotherapy for the Prevention of Migraine

A Markov Model Application

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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