BACKGROUND

Migraines are a debilitating, neurological disorder that manifest as recurrent, unilateral headaches with symptoms such as photophobia, phonophobia and nausea. The self-reported prevalence of migraines in the United States (US) population is high, with roughly one out of six Americans affected over a 3-month period. In the US, the annual cost associated with migraine was estimated to be $36 billion, including healthcare resource utilization and productivity losses. The American Headache Society guideline for the treatment of acute migraines classifies all triptans, including combination therapies, as level A – effective, but does not differentiate between triptans. Additionally, there is no published literature comparing the value of a combination sumatriptan/naproxen therapy to sumatriptan.

OBJECTIVES

The objective of this study was to evaluate the incremental cost per quality-adjusted life years gained (QALYs) of oral combination sumatriptan/naproxen (85 mg/500 mg) versus oral sumatriptan (100 mg) in patients with moderate to severe migraines.

METHODS

The analysis was conducted using a decision tree with a 24-hour timeframe to capture the duration of a migraine attack. Parameter estimates were based on a head-to-head trial comparing the two therapies. Each migraine event lasted for one day; the time horizon for the model was 1 year, accounting for between two and six, moderate to severe migraines per month. The cost utility analysis was conducted from a healthcare perspective. The effect of uncertainty in model parameters was estimated using univariate and probabilistic sensitivity analyses.

RESULTS

From a healthcare perspective, the decision to use sumatriptan/naproxen compared to sumatriptan resulted in an incremental cost-effectiveness ratio (ICER) of $234,381 per QALY gained, with a 95% credible range from $103,689-$459,444.

CONCLUSIONS

Using the accepted ICER threshold of $150,000 per QALY gained, the use of sumatriptan/naproxen does not provide good value. Using each drug as a separately may provide greater dosing flexibility at a lower cost.