Cost-effectiveness of down scheduling triptans in Australia

Research output: Contribution to journalMeeting abstractResearch

Abstract

Objectives: Migraine is a common, chronic, disabling headache disorder. Triptans, an acute treatment for migraine, are available via prescription (Rx) in Australia. Between 2005 and 2009 the Australian Therapeutic Goods Administration (TGA) rejected several submissions to allow triptans to be available over-the-counter (OTC) largely based on concerns about patient risk. However, OTC triptans may help patients self-medicate before symptoms progress and thus improve health outcomes. This study applied an economic evaluation approach to estimate the cost-effectiveness of down-scheduling triptans from Rx to OTC in Australia.

Methods: A decision analytic model was used to synthesise data from a variety of sources. Behaviour before and after down-scheduling was estimated using medical practitioner and patient surveys, and administrative data. Health outcomes included migraine frequency and duration and a wide range of adverse events (AEs) considered by the TGA, obtained from network meta-analyses of trials and observational data. Costs included those related to GP consultations, medicines, pharmacist time, emergency department visits, hospitalisations, and AEs.

Results: It was predicted that down-scheduling triptans will reduce migraine duration, but increase AEs, and would result in 955 QALYs gained at a cost of A$8.1 million over ten years. The ICER was estimated to be A$8,458 per QALY gained, which is likely to be considered ‘cost-effective’. Further research is needed regarding the use of OTC triptans by non-migraineurs, and the incidence of chronic headache and the risk of cardiovascular events with triptans versus other acute treatments. Conversely, serotonin syndrome, a key concern of the TGA, had little impact on the results. Finally it was predicted that, down-scheduling triptans is unlikely to be cost-effective if the Migraine Questionnaire, a patient screening tool, is not implemented.

Conclusions: This study demonstrated that an economic evaluation approach can be used to inform regulatory decisions regarding access to medicines.
LanguageEnglish
Article numberPND16
PagesS94
Number of pages1
JournalValue in Health
Volume21
Issue numberSuppl. 2
DOIs
Publication statusPublished - Sep 2018
EventInternational Society for Pharmacoeconomics and Outcomes Research, 8th Asia-Pacific Conference - Keio Plaza, Tokyo, Japan
Duration: 8 Sep 201811 Sep 2018

Fingerprint

Tryptamines
Cost-Benefit Analysis
Migraine Disorders
Headache Disorders
Costs and Cost Analysis
Quality-Adjusted Life Years
Serotonin Syndrome
Therapeutics
Health
Pharmacists
Prescriptions
Hospital Emergency Service
Hospitalization
Referral and Consultation
Incidence

Cite this

@article{208bd147b5ec4325819f6ff12ee12d31,
title = "Cost-effectiveness of down scheduling triptans in Australia",
abstract = "Objectives: Migraine is a common, chronic, disabling headache disorder. Triptans, an acute treatment for migraine, are available via prescription (Rx) in Australia. Between 2005 and 2009 the Australian Therapeutic Goods Administration (TGA) rejected several submissions to allow triptans to be available over-the-counter (OTC) largely based on concerns about patient risk. However, OTC triptans may help patients self-medicate before symptoms progress and thus improve health outcomes. This study applied an economic evaluation approach to estimate the cost-effectiveness of down-scheduling triptans from Rx to OTC in Australia.Methods: A decision analytic model was used to synthesise data from a variety of sources. Behaviour before and after down-scheduling was estimated using medical practitioner and patient surveys, and administrative data. Health outcomes included migraine frequency and duration and a wide range of adverse events (AEs) considered by the TGA, obtained from network meta-analyses of trials and observational data. Costs included those related to GP consultations, medicines, pharmacist time, emergency department visits, hospitalisations, and AEs.Results: It was predicted that down-scheduling triptans will reduce migraine duration, but increase AEs, and would result in 955 QALYs gained at a cost of A$8.1 million over ten years. The ICER was estimated to be A$8,458 per QALY gained, which is likely to be considered ‘cost-effective’. Further research is needed regarding the use of OTC triptans by non-migraineurs, and the incidence of chronic headache and the risk of cardiovascular events with triptans versus other acute treatments. Conversely, serotonin syndrome, a key concern of the TGA, had little impact on the results. Finally it was predicted that, down-scheduling triptans is unlikely to be cost-effective if the Migraine Questionnaire, a patient screening tool, is not implemented.Conclusions: This study demonstrated that an economic evaluation approach can be used to inform regulatory decisions regarding access to medicines.",
author = "B. Parkinson and M. Gumbie and Henry Cutler",
year = "2018",
month = "9",
doi = "10.1016/j.jval.2018.07.710",
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pages = "S94",
journal = "Value in Health",
issn = "1098-3015",
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}

Cost-effectiveness of down scheduling triptans in Australia. / Parkinson, B.; Gumbie, M.; Cutler, Henry.

In: Value in Health, Vol. 21, No. Suppl. 2, PND16, 09.2018, p. S94.

Research output: Contribution to journalMeeting abstractResearch

TY - JOUR

T1 - Cost-effectiveness of down scheduling triptans in Australia

AU - Parkinson, B.

AU - Gumbie, M.

AU - Cutler, Henry

PY - 2018/9

Y1 - 2018/9

N2 - Objectives: Migraine is a common, chronic, disabling headache disorder. Triptans, an acute treatment for migraine, are available via prescription (Rx) in Australia. Between 2005 and 2009 the Australian Therapeutic Goods Administration (TGA) rejected several submissions to allow triptans to be available over-the-counter (OTC) largely based on concerns about patient risk. However, OTC triptans may help patients self-medicate before symptoms progress and thus improve health outcomes. This study applied an economic evaluation approach to estimate the cost-effectiveness of down-scheduling triptans from Rx to OTC in Australia.Methods: A decision analytic model was used to synthesise data from a variety of sources. Behaviour before and after down-scheduling was estimated using medical practitioner and patient surveys, and administrative data. Health outcomes included migraine frequency and duration and a wide range of adverse events (AEs) considered by the TGA, obtained from network meta-analyses of trials and observational data. Costs included those related to GP consultations, medicines, pharmacist time, emergency department visits, hospitalisations, and AEs.Results: It was predicted that down-scheduling triptans will reduce migraine duration, but increase AEs, and would result in 955 QALYs gained at a cost of A$8.1 million over ten years. The ICER was estimated to be A$8,458 per QALY gained, which is likely to be considered ‘cost-effective’. Further research is needed regarding the use of OTC triptans by non-migraineurs, and the incidence of chronic headache and the risk of cardiovascular events with triptans versus other acute treatments. Conversely, serotonin syndrome, a key concern of the TGA, had little impact on the results. Finally it was predicted that, down-scheduling triptans is unlikely to be cost-effective if the Migraine Questionnaire, a patient screening tool, is not implemented.Conclusions: This study demonstrated that an economic evaluation approach can be used to inform regulatory decisions regarding access to medicines.

AB - Objectives: Migraine is a common, chronic, disabling headache disorder. Triptans, an acute treatment for migraine, are available via prescription (Rx) in Australia. Between 2005 and 2009 the Australian Therapeutic Goods Administration (TGA) rejected several submissions to allow triptans to be available over-the-counter (OTC) largely based on concerns about patient risk. However, OTC triptans may help patients self-medicate before symptoms progress and thus improve health outcomes. This study applied an economic evaluation approach to estimate the cost-effectiveness of down-scheduling triptans from Rx to OTC in Australia.Methods: A decision analytic model was used to synthesise data from a variety of sources. Behaviour before and after down-scheduling was estimated using medical practitioner and patient surveys, and administrative data. Health outcomes included migraine frequency and duration and a wide range of adverse events (AEs) considered by the TGA, obtained from network meta-analyses of trials and observational data. Costs included those related to GP consultations, medicines, pharmacist time, emergency department visits, hospitalisations, and AEs.Results: It was predicted that down-scheduling triptans will reduce migraine duration, but increase AEs, and would result in 955 QALYs gained at a cost of A$8.1 million over ten years. The ICER was estimated to be A$8,458 per QALY gained, which is likely to be considered ‘cost-effective’. Further research is needed regarding the use of OTC triptans by non-migraineurs, and the incidence of chronic headache and the risk of cardiovascular events with triptans versus other acute treatments. Conversely, serotonin syndrome, a key concern of the TGA, had little impact on the results. Finally it was predicted that, down-scheduling triptans is unlikely to be cost-effective if the Migraine Questionnaire, a patient screening tool, is not implemented.Conclusions: This study demonstrated that an economic evaluation approach can be used to inform regulatory decisions regarding access to medicines.

U2 - 10.1016/j.jval.2018.07.710

DO - 10.1016/j.jval.2018.07.710

M3 - Meeting abstract

VL - 21

SP - S94

JO - Value in Health

T2 - Value in Health

JF - Value in Health

SN - 1098-3015

IS - Suppl. 2

M1 - PND16

ER -