Cost considerations in acute and prophylactic migraine treatment

The modem management of migraine demands economic in addition to the medica l considerations. Triptans for instance ore new migraine acute-care drugs d emonstrating high effectiveness and exellent safety profiles but are, howev er, much more expensive than conventional analgesics. To save costs, they s hould only be administered when nonsteroidal anti-inflammatory drugs and er gotamin derivatives have proven to be ineffective. Prescription of migraine -prophylactic drugs should consider comorbidity and side effects. To determ ine the cost-effectiveness of various migraine-prophylactic drugs in relati on to acute-care drugs, the cost-equivalent number con be calculated. A cos t-equivalent number lower than the migraine frequency suggests that the use of a prophylactic drug will be cost-effective. The formula to calculate th e cost-equivalent number is derived and its use is demonstrated.