Cost-effectiveness and cost-benefit of sumatriptan in patients with migraine

Objective: To investigate the cost-effectiveness and cost-benefit of initia ting sumatriptan therapy in patients with acute migraine who were previousl y taking nontriptan drugs. Patients and Methods: This is an economic analysis of a prospective, pretes t-posttest, observational 6-month outcomes study of 178 patients with a phy sician diagnosis of migraine who received their first prescription for suma triptan between October 1994 and August 1996 and were members of a mixed-mo del managed care organization in western Pennsylvania. Migraine-related res ource use data were obtained from the managed care organization's medical a nd pharmacy claims databases. The primary outcome measure for this economic analysis was the total disability time that patients experienced because o f migraine. Patients reported time missed from work and usual nonwork activ ities because of migraine on self-administered questionnaires at baseline a nd at 3 and 6 months after initiation of sumatriptan. Results: Initiation of sumatriptan resulted in a decrease of 662 migraine-d isability-days for work and 1236 migraine-disability-days for nonwork activ ities during the 6 months of the study (decrease from 27.8 to 17.2 days per person), totaling 1898 migraine-disability-days averted with sumatriptan t herapy. Migraine-related medical costs were lower after sumatriptan was ini tiated ($18,351 vs $26,192), whereas migraine-related pharmacy costs were l ower with prior nontriptan drug therapy ($22,209 vs $74,861). The overall n et cost savings after sumatriptan was initiated in these patients was $222, 332 ($1249 per patient) with a benefit-to-cost ratio of $5.67 gained for ea ch health care dollar spent from a societal perspective. The incremental co st-effectiveness ratio was $25 for each additional migraine-disability-day averted by using sumatriptan vs nontriptan drug therapy. Sensitivity analys is showed that changes in medical costs had little effect on the ratios and that sumatriptan remained cost-beneficial across a wide range of patient w ages. Conclusion: This study showed that initiation of sumatriptan in patients pr eviously receiving nontriptan therapy was cost-effective and had an economi c benefit for patients, employers, and society. Sumatriptan also helped pat ients and physicians achieve goals recommended by the US Headache Consortiu m by reducing patients' disability and thus improving their ability to func tion at work and nonwork activities.