Class of 2007 Abstract / Objectives: To compare the cost-effectiveness of amitriptyline, divalproex, propranolol, and topiramate in the prophylactic treatment of migraine headaches based on published data.
Methods: A MEDLINE search was done to identify all randomized, controlled clinical trials evaluating the efficacy of amitriptyline, divalproex, propranolol, and topiramate in the prophylactic treatment of migraine headaches. Results from these studies were then combined with drug cost and health care service costs related to treatment failure and adverse events to assess the relative cost-effectiveness of each medication. A decision tree model was created and Monte Carlo simulation was done to determine each products cost-effectiveness.
Results: Amitriptyline was both most effective and least costly of the four treatment regimens studied. The mean costs for a 90 day treatment of each of the four respective medications were found to be: amitriptyline $62, divalproex $450, propranolol $91, and topiramate $802. An acceptability curve demonstrated that amitriptyline was most cost-effective 90% of the time, propranolol 10% of the time, and divalproex and topiramate were never the most cost-effective treatment.
Conclusions: Among the most common medications used for migraine prophylaxis are amitriptyline, divalproex, propranolol, and topiramate. Based upon this analysis, amitriptyline was found to be the most cost-effective medication. Therefore, it is logical from the perspective of a managed-care organization to recommend amitriptyline as a first-line agent for migraine prophylaxis.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/624402 |
| Date | January 2007 |
| Creators | Hunter, Rebekka, Rouff, David |
| Contributors | Armstrong, Edward, College of Pharmacy, The University of Arizona |
| Publisher | The University of Arizona. |
| Source Sets | University of Arizona |
| Language | en_US |
| Detected Language | English |
| Type | text, Electronic Report |
| Rights | Copyright © is held by the author. |
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