Cost considerations of acute migraine treatment

Objective.-To provide medication price data and cost-reducing strategies for the acute treatment of migraine. Methods.-Retail prices for common acute care medications were found at www.drugstore.com. Cost-reduction tactics were obtained from literature searches and clinical experience. Results.-Several strategies can reduce cost without sacrificing treatment outcome. In mild to moderate migraine, low-priced nonsteroidal anti-inflammatory drugs can be used as first-line medications due to their proven efficacy and favorable tolerability. For patients with more severe migraine, implementing a stratified care approach-using migraine-specific medications early in acute treatment-is cost-effective for most patients. Stratified care not only improves outcome and decreases disability, but also reduces cost. Pill splitting and early administration of triptans within an attack enhance their value. Supplying rescue medications, such as opioids, sedatives, and phenothiazines, can prevent emergency department visits. Minimizing multiple dosing of triptans and reducing utilization of expensive health care resources are key factors in reducing the cost of effective migraine treatment. An important affordability factor for patients with co-payments is the number of triptan pills per package. Sumatriptan, naratriptan, and frovatriptan each contain 9 tablets per package, while most other triptan packages contain 6. Current triptan retail prices (per unit) include: Amerge 1 and 2.5 mg, $17.78; Axert 6.25 and 12.5 mg, $16.31; Frova 2.5 mg, $13.89; Imitrex 50 mg, $14.96; Imitrex 100 mg, $14.41; Imitrex Nasal Spray 20 mg, $21.61; Imitrex SQ 6 mg, $50.26; Maxalt 5 and 10 mg, $15; Maxalt-MLT 5 and 10 mg, $15; Relpax 40 mg, $13.58; Zomig 2.5 mg, $13.67; Zomig 5 mg, $15.89; Zomig-ZMT 2.5 mg, $13.67; and Zomig- ZMT 5 mg, $15.89. Conclusions.-Practitioners can optimize the use of health care dollars without compromising quality of care through awareness of cost-saving treatment strategies, as well as price variations among medications.