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Cost effectiveness of pharmacotherapy for the prevention of migraine: a Markov model application.

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Title: Cost effectiveness of pharmacotherapy for the prevention of migraine: a Markov model application.
Authors: Yu J (AUTHOR), Smith KJ (AUTHOR), Brixner DI (AUTHOR), Yu, Junhua (AUTHOR), Smith, Kenneth J (AUTHOR), Brixner, Diana I (AUTHOR)
Source: CNS Drugs. 2010, Vol. 24 Issue 8, p695-712. 18p.
Abstract: Background: There are few data about the cost effectiveness of prophylactic medications for migraine. Clinical trials have shown several preventive agents to be useful in reducing the frequency of migraine attack while having tolerable side effects.Objective: To compare the cost effectiveness of adding preventive treatment to abortive therapy for acute migraine with abortive therapy for acute migraine alone in the primary care setting.Methods: A Markov decision analytic model with a cycle length of 1 day, a time horizon of 365 days and three health states was used to perform an analysis comparing the cost effectiveness and utility of five treatments for migraine prophylaxis (amitriptyline 75 mg/day, topiramate 100 and 200 mg/day, timolol 20 mg/day, divalproex sodium 1000 mg/day or propranolol 160 mg/day) with treatment of acute migraine alone for the management of migraine in the primary care setting. One-way and probabilistic sensitivity analyses were performed to test the robustness of the results.Results: The expected total annual cost for the use of preventive agents ranged from $US2932 to $US3887, compared with $US3960 for the use of abortive medications only. In the baseline analysis, use of each of the five preventive agents generated more quality-adjusted life-years (QALYs) and incurred lower costs compared with abortive medications only. Monte Carlo Simulation suggested that amitriptyline 75 mg/day was most likely to be considered a cost-effective option versus the other five therapies, followed by timolol 20 mg/day, topiramate 200 mg/day, topiramate 100 mg/day, divalproex sodium 1000 mg/day and propranolol 160 mg/day when the willingness-to-pay (WTP) for society is <$US18 000 per QALY gained.Conclusions: Preventive medications appear to be a cost-effective approach to the management of migraine in the primary care setting compared with the approach of abortive treatment only. Among those preventive agents, probabilistic sensitivity analysis suggests that, when the societal WTP is <$US18 000 per QALY gained, amitriptyline 75 mg/day is most likely to be considered a cost-effective option. [ABSTRACT FROM AUTHOR]
Copyright of CNS Drugs is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Cost effectiveness of pharmacotherapy for the prevention of migraine: a Markov model application.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Yu+J%22&quot;&gt;Yu J&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Smith+KJ%22&quot;&gt;Smith KJ&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Brixner+DI%22&quot;&gt;Brixner DI&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Yu%2C+Junhua%22&quot;&gt;Yu, Junhua&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Smith%2C+Kenneth+J%22&quot;&gt;Smith, Kenneth J&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Brixner%2C+Diana+I%22&quot;&gt;Brixner, Diana I&lt;/searchLink&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22CNS+Drugs%22&quot;&gt;CNS Drugs&lt;/searchLink&gt;. 2010, Vol. 24 Issue 8, p695-712. 18p.
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: &lt;bold&gt;Background: &lt;/bold&gt;There are few data about the cost effectiveness of prophylactic medications for migraine. Clinical trials have shown several preventive agents to be useful in reducing the frequency of migraine attack while having tolerable side effects.&lt;bold&gt;Objective: &lt;/bold&gt;To compare the cost effectiveness of adding preventive treatment to abortive therapy for acute migraine with abortive therapy for acute migraine alone in the primary care setting.&lt;bold&gt;Methods: &lt;/bold&gt;A Markov decision analytic model with a cycle length of 1 day, a time horizon of 365 days and three health states was used to perform an analysis comparing the cost effectiveness and utility of five treatments for migraine prophylaxis (amitriptyline 75 mg/day, topiramate 100 and 200 mg/day, timolol 20 mg/day, divalproex sodium 1000 mg/day or propranolol 160 mg/day) with treatment of acute migraine alone for the management of migraine in the primary care setting. One-way and probabilistic sensitivity analyses were performed to test the robustness of the results.&lt;bold&gt;Results: &lt;/bold&gt;The expected total annual cost for the use of preventive agents ranged from $US2932 to $US3887, compared with $US3960 for the use of abortive medications only. In the baseline analysis, use of each of the five preventive agents generated more quality-adjusted life-years (QALYs) and incurred lower costs compared with abortive medications only. Monte Carlo Simulation suggested that amitriptyline 75 mg/day was most likely to be considered a cost-effective option versus the other five therapies, followed by timolol 20 mg/day, topiramate 200 mg/day, topiramate 100 mg/day, divalproex sodium 1000 mg/day and propranolol 160 mg/day when the willingness-to-pay (WTP) for society is &lt;$US18 000 per QALY gained.&lt;bold&gt;Conclusions: &lt;/bold&gt;Preventive medications appear to be a cost-effective approach to the management of migraine in the primary care setting compared with the approach of abortive treatment only. Among those preventive agents, probabilistic sensitivity analysis suggests that, when the societal WTP is &lt;$US18 000 per QALY gained, amitriptyline 75 mg/day is most likely to be considered a cost-effective option. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of CNS Drugs is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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