Cost savings in migraine associated with less chest pain on new triptan therapy.
Am J Manag Care. 2002 Feb;8(3 Suppl):S102-S107 Objectives: This article constructs an economic model to estimate cost of chest-pain-related care in migraine patients receiving almotriptan 12.5 mg compared with those receiving sumatriptan 50 mg. Study Design: This population-based, retrospective cohort study used data from the MEDSTAT Marketscan database (Ann Arbor, Michigan) to quantify incidence and costs of chest-pain-related diagnoses and procedures. After a 6-month exclusion period, the study used a pre-post design, with baseline and treatment periods defined, respectively, as 5 months before and after receiving sumatriptan therapy. An economic model was constructed to estimate annual cost savings per 1,000 patients receiving almotriptan instead of sumatriptan as a function of differing rates of chest pain. Annual direct medical cost avoided was calculated for a hypothetical health plan covering 1 million lives. Results: Among a cohort of 1,390 patients, the incidence of chest-pain-related diagnoses increased significantly (43.6%) with sumatriptan, from 110 during the baseline period to 158 during the treatment period (P = .003). Aggregate costs for chest-pain-related diagnoses and procedures increased 33.1%, from $22,713 to $30,234. Payments for inpatient hospital services rose 10-fold; costs for primary care visits and outpatient hospital visits rose 53.1% and 14.4%, respectively. Payments for angiography increased from $0 to $462, and costs for chest radiographs and electrocardiograms increased 58.7% and 31.2%, respectively. Sumatriptan treatment was associated with a 3-fold increase in payments for services for painful respiration and other chest pain. The model predicted $11,215 in direct medical cost savings annually per 1000 patients treated with almotriptan instead of sumatriptan. Annual direct medical costs avoided for the health plan totaled $195,913. Conclusion: Using almotriptan instead of sumatriptan will likely reduce the cost of chest-pain-related care for patients with migraine headaches. Comment: In my view, this study takes conjecture a step too far. The lower reported chest adverse events (AEs) reported in clinical trials where all AEs are scrutinized will not necessarily lead to lower reporting in the clinic. This hypothesis remains to be proven in a well-designed post-marketing surveillance program, untarnished by commercial sponsorship. Until such an independent prospective study is carried out, the extrapolations described here and in similar papers are pure conjecture and should be classed as the lowest grade of evidence on a par with uncorroborated clinical opinion. DSM
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Document Type: Research Article
Publication date: 2003-03-01