SUMATRIPTAN - A PHARMACOECONOMIC REVIEW OF ITS USE IN MIGRAINE

Migraine is a common illness characterised by severe,often throbbing a nd/or unilateral headache, which may be accompanied by sensitivity to light or noise. A minority of migraine attacks are preceded by transie nt visual or sensory disturbances. Migraine is associated with reducti ons in health-related quality of life,both during and between attacks. Despite methodological limitations in cost-of-illness studies, it is clear that the cost of migraine to society is substantial. Indirect co sts (primarily workplace productivity losses) make up 75 to 90% of tot al costs. Direct costs, such as the cost of drug treatment, physician consultation, hospitalisation and emergency room treatment, make up mo st of the remainder. Sumatriptan is an effective and well tolerated ag ent in the treatment of migraine. Its main advantage over other agents used in the acute management of migraine appears to be its rapid onse t of action. Sumatriptan reduces headache severity within 2 hours of o ral administration in 50 to 67% of patients and within 1 hour of subcu taneous administration in 70 to 80% of patients. Headache recurs in ap proximately 40% of patients who initially respond to oral or subcutane ous sumatriptan; however a second dose of the drug is effective agains t the symptoms of recurrence in a majority of patients. Some patients experience relief of nonheadache migraine symptoms, including nausea, vomiting, photophobia and phonophobia. Adverse events reported after s umatriptan are generally mild and transient. Data from studies of pati ents who used their usual therapies and sumatriptan is nonblinded, seq uential phases indicate that both workplace and nonworkplace productiv ity loses were reduced during sumatriptan therapy. A cost-benefit anal ysis applied to some of these workplace productivity data indicated th at, included direct costs and productivity savings, sumatriptan was as sociated with a net reduction in total cost of migraine. In retrospect ive costs analyses, sumatriptan was associated with increased prescrip tion costs; the effect of the drug on other direct treatment costs was less clear. A retrospective pharmacoeconomic model suggested that the cost-effective of subcutaneous sumatriptan versus subcutaneous dihydr oergotamine depended on which outcome measure was of greatest interest . For measures of rapid relief of migraine, sumatriptan was superior, but the cost of achieving rapid relief was substantial. Sumatriptan im proved global quality-of-life scores compared with patients' usual the rapy in a randomised crossover trial and appeared to do the same when the drugs were administered in nonblinded, sequential phases in trials which used general and migraine-specific quality-of-life instruments. Thus, sumatriptan is associated with a fast onset of action and impro vements in health-related quality of life in patients with migraine. H owever, the cost of achieving rapid relief of migraine symptoms may be substantial. Compared with patients usual treatments, sumatriptan app eared to reduce workplace and nonworkplace productivity losses. Howeve r, few economic data from well controlled prospective comparisons of s umatriptan with other available agents are available to quantify the e ffect of sumatriptan on the overall cost of migraine.