Cost-effectiveness of down scheduling triptans in Australia

B. Parkinson; M. Gumbie; Henry Cutler

doi:10.1016/j.jval.2018.07.710

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.

Original language	English
Article number	PND16
Pages (from-to)	S94
Number of pages	1
Journal	Value in Health
Volume	21
Issue number	Suppl. 2
DOIs	https://doi.org/10.1016/j.jval.2018.07.710
Publication status	Published - Sept 2018
Event	International Society for Pharmacoeconomics and Outcomes Research, 8th Asia-Pacific Conference - Keio Plaza, Tokyo, Japan Duration: 8 Sept 2018 → 11 Sept 2018

Access to Document

10.1016/j.jval.2018.07.710

Proposed research project for the WSMI general assembly in 2017
Parkinson, B. (Primary Chief Investigator), Cutler, H. (Chief Investigator) & Schroeder, L. (Chief Investigator)
11/03/16 → 31/12/16
Project: Research

Enhancing medicine scheduling decisions through economics
Parkinson, B. (Participant), Cutler, H. (Participant), Mutowo, M. (Participant), Gauld, N. (Participant), Mumford, V. (Participant) & Haywood, P. (Participant)
Impact: Policy impacts, Economy impacts, Quality of life impacts

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 {\textquoteleft}cost-effective{\textquoteright}. 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 = sep,

doi = "10.1016/j.jval.2018.07.710",

language = "English",

volume = "21",

pages = "S94",

journal = "Value in Health",

issn = "1098-3015",

publisher = "Elsevier",

number = "Suppl. 2",

note = "International Society for Pharmacoeconomics and Outcomes Research, 8th Asia-Pacific Conference ; Conference date: 08-09-2018 Through 11-09-2018",

}

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

SN - 1098-3015

VL - 21

SP - S94

JO - Value in Health

JF - Value in Health

IS - Suppl. 2

M1 - PND16

T2 - International Society for Pharmacoeconomics and Outcomes Research, 8th Asia-Pacific Conference

Y2 - 8 September 2018 through 11 September 2018

ER -

Cost-effectiveness of down scheduling triptans in Australia

Abstract

Access to Document

Fingerprint

Projects

Proposed research project for the WSMI general assembly in 2017

Impacts

Enhancing medicine scheduling decisions through economics

Cite this