OBJECTIVE: To assess the cost-effectiveness of the various oral triptan tablets currently available in the US for the acute treatment of migraine headache, and to estimate the prices at which eletriptan and frovatriptan would need to enter the market in order to be competitive. METHODS: This study uses a decision model to evaluate the cost-effectiveness of oral triptan tablets. Average wholesale prices were obtained from the 2002 Drug Topics Red Book. Efficacy data was derived from over 65 double-blind, placebo-controlled clinical trials for almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. Using patient reports for pain relief at 1, 2, and 4 hours post-dose, as well as headache recurrence within 24 hours, and serious side effects, probability estimates for these parameters were calculated by weighting each clinical trial estimate by its sample size. Success was defined as pain relief within 2 hours without headache recurrence within 24 hours and without a serious side effect. Threshold analyses were conducted to determine the prices of eletriptan and frovatriptan. RESULTS: All triptans had similar side effect profiles, but varied markedly in price and efficacy. Almotriptan was the most cost-effective triptan ($35.47 per successful outcome for 12.5 mg tablets, $40.92 for 6.25 mg), followed by rizatriptan ($44.53 for 10 mg, $48.68 for 5mg) and zolmitriptan (2.5 mg $48.88, 5 mg $49.43). All doses of sumatriptan and naratriptan were greater than $50 per successful outcome. To be competitive with almotriptan, eletriptan would need to be priced around $9 per tablet for the 80 mg dose, and $11 per tablet for the 40 mg dose. Frovatriptan 2.5 mg, on the other hand, needs to be priced at $2 per tablet. CONCLUSION: At $10.55 per tablet, almotriptan was the most cost-effective triptan currently marketed in the US. The price for eletriptan must be $11 or less to be equally cost-effective.