Skip to main content
Log in

Economic Evaluation of Oral Sumatriptan Compared with Oral Caffeine/Ergotamine for Migraine

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

We conducted an economic comparison of oral sumatriptan with oral caffeine/ergotamine in the treatment of patients with migraine. Cost-effectiveness, cost-utility and cost-benefit analyses were conducted from societal and health-departmental perspectives. A decision tree was used. Utilities were assigned to health states using the Quality of Weil-Being Scale. Simple and probabilistic sensitivity analyses were also carried out.

From a societal perspective, using sumatriptan instead of caffeine/ergotamine resulted in an incremental cost-effectiveness ratio of-25 Canadian dollars ($Can) per attack aborted, an incremental cost-utility ratio of -$Can7507 per quality-adjusted life-year (QALY), and a net economic benefit of $Can42 per patient per year (1995 values). From the perspective of the health department, the incremental cost-effectiveness ratio was $Can98 per attack aborted, the incremental cost-utility ratio was $Can29 366 per QALY; the grade of recommendation based on past decisions regarding health technology for adoption into health insurance plans was ‘moderate’. Sensitivity analysis showed that the results were robust to relatively large changes in the input variables.

The incremental health benefits obtained from using oral sumatriptan rather than oral caffeine/ergotamine were achieved at moderately acceptable incremental costs, if past decisions on the adoption of other health technologies are used as a guide.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. De Lissosoy G, Lazarus S. The economic cost of migraine: present state of knowledge. Neurology 1994; 44 Suppl. 4: S56–S62

    Google Scholar 

  2. Edmeads J, Findlay H, Tugwell P, et al. Impact of migraine and tension-type headache on life-style, consulting behaviour, and medication use: a Canadian population survey. Can J Neurol Sci 1993; 20 (2): 131–137

    PubMed  CAS  Google Scholar 

  3. Osterhaus J, Gutterman D, Plachetka J. Healthcare resource and lost labour costs of migraine headache in the United States. Pharmacoeconomics 1992; (1): 67–76

    Article  Google Scholar 

  4. Pryse-Phillips W, Findlay H, Tugwell P, et al. A Canadian population survey on the clinical, epidemiologic and societal impact of migraine and tension-type headache. Can J Neurol Sci 1992; 19 (3): 333–339

    PubMed  CAS  Google Scholar 

  5. Humphrey P, Feniuk W, Perren M, et al. The pharmacology of the novel 5-HT1-like receptor agonist, GR43175. Cephalalgia 1989; 9 Suppl. 9: 23–33

    PubMed  Google Scholar 

  6. Buzzi M, Moskowitz M. The antimigraine drug, sumatriptan (GR43175), selectively blocks neurogenic plasma extravasation from blood vessels in dura mater. Br J Pharmacol 1990; 99: 202–206

    Article  PubMed  CAS  Google Scholar 

  7. Glaxo Welcome Inc. Product monograph of Imitrex. Mississauga, Ontario: Glaxo Welcome Inc., 1996

    Google Scholar 

  8. Hoffert M. Treatment of migraine: a new era. Am Fam Physician 1994; 49 (3): 633–638

    PubMed  CAS  Google Scholar 

  9. Canadian Pharmaceutical Association. Compendium of pharmaceutical specialties. 30th ed. Ottawa: Canadian Pharmaceutical Association, 1995

    Google Scholar 

  10. Schmidt R, Fanchamps A. Effect of caffeine on intestinal absorption of ergotamine in man. Eur J Clin Pharmacol 1974; 7: 213–216

    Article  PubMed  CAS  Google Scholar 

  11. Welch K. Drug therapy of migraine. N Engl J Med 1993; 329: 1476–1483

    Article  PubMed  CAS  Google Scholar 

  12. Multinational Oral Sumatriptan and Cafergot Comparative Study Group. A randomized, double-blind comparison of sumatriptan and Cafergot in the acute treatment of migraine. Eur Neurol 1991; 31 (5): 314–322

    Article  Google Scholar 

  13. Cutler N, Mushet G, Davis R, et al. Oral sumatriptan for the acute treatment of migraine: evaluation of three dosage strengths. Neurology 1995; 45 (8 Suppl. 7): S5–S9

    PubMed  CAS  Google Scholar 

  14. Goadsby P, Zagami A, Donnan G. Oral sumatriptan in acute migraine. Lancet 1991; 338 (8770): 782–783

    Article  PubMed  CAS  Google Scholar 

  15. Nappi G, Sicuteri F, Byrne M, et al. Oral sumatriptan compared with placebo in the acute treatment of migraine. J Neurol 1994; 241 (3): 138–144

    Article  PubMed  CAS  Google Scholar 

  16. Oral Sumatriptan and Aspirin plus Metoclopramide Comparative Study Group. A study to compare oral sumatriptan with oral aspirin plus oral metoclopramide in the acute treatment of migraine. Eur Neurol 1992; 32 (3): 177–184

    Article  Google Scholar 

  17. Oral Sumatriptan Dose-Defining Study Group. Sumatriptan: an oral dose-defining study. Eur Neurol 1991; 31 (5): 300–305

    Article  Google Scholar 

  18. Oral Sumatriptan Dose-Defining Study Group. Clinical experience with oral sumatriptan: a placebo-controlled, dose-ranging study. J Neurol 1991; 238 Suppl. 1: S62–S65

    Article  Google Scholar 

  19. Oral Sumatriptan International Multiple-Dose Study Group. Evaluation of a multiple-dose regimen of oral sumatriptan for the acute treatment of migraine. Eur Neurol 1991; 31 (5): 306–313

    Article  Google Scholar 

  20. Pini L, Sternieri E, Fabbri L, et al. High efficacy and low frequency of headache recurrence after oral sumatriptan. J Int Med Res 1995; 23 (2): 96–105

    PubMed  CAS  Google Scholar 

  21. Rederich G, Rapoport A, Cutler N, et al. Oral sumatriptan for the long-term treatment of migraine: clinical findings. Neurology 1995; 45 (8 Suppl. 7): S15–S20

    PubMed  CAS  Google Scholar 

  22. Sargent J, Kirchner J, Davis R, et al. Oral sumatriptan is effective and well tolerated for the acute treatment of migraine: results of a multicenter study. Neurology 1995; 45 (8 Suppl. 7): S10–S14

    PubMed  CAS  Google Scholar 

  23. Tfelt-Hansen P, Henry P, Mulder L, et al. The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine. Lancet 1995; 346 (8980): 923–926

    Article  PubMed  CAS  Google Scholar 

  24. Weinstein M, Fineberg H. Clinical decision analysis. Philadelphia: W.B. Saunders, 1980

    Google Scholar 

  25. Drummond M, Stoddart G, Torrance G. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1987

    Google Scholar 

  26. Hull R, Hirsh J, Sackett D, et al. Cost-effectiveness of clinical diagnosis, venography and non-invasive testing in patients with symptomatic deep vein thrombosis. N Engl J Med 1981; 304: 1561–1567

    Article  PubMed  CAS  Google Scholar 

  27. Statistics Canada. Hospital annual statistics. Ottawa: Statistics Canada, 1992. Catalogue no.: 83-242

    Google Scholar 

  28. Canadian Institute for Health Information. Guidelines for management information systems in Canadian health care facilities: diagnostic and therapeutic services. Ottawa: Canadian Institute for Health Information, 1995

    Google Scholar 

  29. Statistics Canada. Selected income statistics. Ottawa: Statistics Canada, 1991. Catalogue no.: 93-331

    Google Scholar 

  30. Statistics Canada. Consumer prices and price indexes. Ottawa: Statistics Canada, 1995. Catalogue no.: 62-010

    Google Scholar 

  31. Kaplan R, Anderson J. A general health model: update and applications. Health Serv Res 1988; 23: 203–235

    PubMed  CAS  Google Scholar 

  32. Nord E, Richardson J, Macarounas-Kirchmann K. Social evaluation of health care versus personal evaluation of health states: evidence on the validity of four health state scaling instruments using Norwegian and Australian surveys. Int J Technol Assess Health Care 1993; 9: 463–478

    Article  PubMed  CAS  Google Scholar 

  33. Eddy D. Oregon’s methods: did cost-effectiveness analysis fail? J AM A 1991; 266: 2135–2141

    CAS  Google Scholar 

  34. Laupacis A, Feeny D, Detsky A, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J 1992; 146 (4): 473–481

    CAS  Google Scholar 

  35. Boyle M, Torrance G, Sinclair J, et al. Economic evaluation of neonatal intensive care of very-low-birth-weight infants. N Engl J Med 1983; 308: 1330–1337

    Article  PubMed  CAS  Google Scholar 

  36. Doubilet P, Begg C, Weinstein M, et al. Probabilistic sensitivity analysis using Monte Carlo simulation: a practical approach. Med Decis Making 1985; 5 (2): 157–177

    Article  PubMed  CAS  Google Scholar 

  37. Evans K, Boan J, Evans J, et al. Meta-analysis and economic evaluation of sumatriptan for migraine. Ottawa: Canadian Coordinating Office for Health Technology Assessment, 1996.

    Google Scholar 

  38. Office of Technology Assessment, US Congress. Identifying Health Technologies that Work: searching for evidence. Washington, DC: US Government Printing Office, 1994. Report no.: OTA-H-608

    Google Scholar 

  39. Brown E, Endersby C, Smith R, et al. The safety and tolerability of sumatriptan: an overview. Eur Neurol 1991; 31: 339–344

    Article  PubMed  CAS  Google Scholar 

  40. Simmons V, Blakeborough P. The safety profile of sumatriptan. Rev Contemporary Pharmacother 1994; 5: 319–328

    Google Scholar 

  41. Sullivan J, Preston K, Testa M, et al. Psychoactivity and abuse potential of sumatriptan. Clin Pharmacology Ther 1992; 52 (6): 635–642

    Article  CAS  Google Scholar 

  42. Tansey M, Pilgrim A, Martin P. Long-term experience with sumatriptan in the treatment of migraine. Eur Neurol 1993; 33: 310–315

    Article  PubMed  CAS  Google Scholar 

  43. Wilkinson M, Pfaffenrath V, Schoenen J, et al. Migraine and cluster headache — their management with sumatriptan: a critical review of the current clinical experience. Cephalalgia 1995; 15: 337–357

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kenneth W. Evans.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Evans, K.W., Boan, J.A., Evans, J.L. et al. Economic Evaluation of Oral Sumatriptan Compared with Oral Caffeine/Ergotamine for Migraine. Pharmacoeconomics 12, 565–577 (1997). https://doi.org/10.2165/00019053-199712050-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199712050-00007

Keywords

Navigation