OBJECTIVES: A composite outcome measure in migraine treatment assessment is useful to clinical decision makers and payers as it provides a more accurate reflection of effectiveness and allows for more complete modeling of economic value. This composite measure must consider both short- and long-term treatment effects, as well as placebo effects. The objective of this study was to compare the total triptan cost to treat 100 migraine-patient attacks and the cost per successfully treated patient (CPSTP) for six marketed triptans using a composite measure of effectiveness, the 'successfully treated' migraine (defined as requiring only one triptan dose to treat one migraine attack during a 24-hour period). METHODS: This analysis was conducted from the perspective of the payer. Clinical data were abstracted from a rigorous, published meta-analysis. Two-hour response and pain-free response were used in conjunction with the recurrence rate reported in the meta-analysis to calculate the number of doses used by treatment successes and failures. The average wholesale price per dose was then used to calculate total triptan cost. RESULTS: Of the nine oral triptan doses compared, eletriptan 40mg was associated with both the lowest total triptan cost for treating 100 migraine attacks ($1560) and with the lowest CPSTP ($56.39). CONCLUSIONS: The relative CPSTP for migraine therapies is dependent on the definition of treatment success and relative pricing. When success is defined as using one triptan dose to treat one migraine attack in a 24-hour period, the triptans with the most value to managed care organizations, in terms of cost per successfully treated patient, are eletriptan 40mg ($56.39), zolmitriptan 2.5mg ($75.62) and sumatriptan 50mg ($77.59).