Cost-Effectiveness of Eletriptan in Acute Migraine Treatment

Triptans in Acute Migraine Treatment

Triptans are used in the acute treatment of migraine during moderately to severely painful attacks or during mild attacks that do not respond to analgesics and anti-inflammatory drugs. The first triptan on the market was sumatriptan. Over time, another 6 triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, and zolmitriptan) were registered, which exhibit more favorable pharmacokinetic properties. According to a 2012 meta-analysis, all triptans can alleviate migraine pain within 2 hours in 49–69% of patients treated for moderate to severe migraine, with the greatest pain relief observed with 40 mg eletriptan and 10 mg rizatriptan. Triptans can thus improve the quality of life of patients and their economic benefit – in the form of reduced demand for further treatment and healthcare and reduced loss of work productivity – may outweigh the costs of treatment. Most triptans are now also available in generic forms.

Eletriptan

Eletriptan is an oral lipophilic highly selective agonist of serotonin 5-HT_1B/1D receptors. In a 40 mg dose, it has demonstrated superiority in alleviating moderate to severe migraine attacks compared to 50 mg and 100 mg sumatriptan, 2.5 mg naratriptan, and 2.5 mg zolmitriptan. It has also shown effectiveness in attacks that do not respond to sumatriptan, rizatriptan, or nonsteroidal anti-inflammatory drugs. It is a safe medication, with side effects being rare and usually mild to moderate. Compared to placebo, the most commonly reported side effects are dizziness (6% vs. 3%), drowsiness (6% vs. 4%), and asthenia (5% vs. 3%).

Systematic Literature Review

The aim of the cited literature review was to summarize available pharmacoeconomic data on eletriptan compared to other triptans. Included were works published in English that provided pharmacoeconomic data on eletriptan at market-available doses and simultaneously on at least one other triptan. The review was conducted in the MEDLINE database. The authors identified 8 works, of which 5 were conducted in the European Union and 3 in the United States: 7 of these studies evaluated pharmacoeconomic data on eletriptan compared to another triptan, and 1 evaluated healthcare costs when using 40 mg eletriptan compared to 100 mg sumatriptan.

Comparison Results

Eletriptan 40 mg, along with 10 mg rizatriptan and 12.5 mg almotriptan, demonstrated the greatest cost-effectiveness. This conclusion was reached through evaluations using various efficacy parameters (such as pain absence within 2 hours, sustained pain absence, and sustained pain absence without side effects) and cost-effectiveness models that included, beyond drug prices, the administration of a second dose of triptan during a migraine attack, rescue medication administration, treatment of adverse events, and loss of work productivity.

However, there were minimal direct comparisons available, and indirect costs were rarely included, despite most costs associated with migraine being attributable to them.

Conclusion

Despite its limitations, this literature review demonstrated that 40 mg eletriptan is among the most cost-effective triptans in treating migraine attacks. Studies conducted across different regions of the EU and the USA reached these results. This may be due to its high efficacy, which reduces the need for additional acute migraine treatment or switching to another medication. The conclusions are consistent with a previous pharmacoeconomic review of triptans by Canadian authors, which identified eletriptan, rizatriptan, and almotriptan as the most cost-effective triptans.

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Source: Bhambri R., Mardekian J., Liu L. Z. et al. A review of the pharmacoeconomics of eletriptan for the acute treatment of migraine. Int J Gen Med 2015; 8: 27−36, doi: 10.2147/IJGM.S73673.