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Work productivity and resource consumption among migraineurs under current treatment and during treatment with sumatriptan: an economic evaluation of acute treatment in moderate to severe migraineurs |
Larbig W, Bruggenjurgen B |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Sumatriptan in moderate to severe migraineurs. Up to two sumatriptan 6mg injections were administered in 24 hours.
Economic study type Cost-effectiveness analysis.
Study population Male and female migraineurs aged between 18 and 65 years who regularly suffered from moderate to severe migraine attacks with or without aura, as defined by the International Headache Society (IHS) 1988 diagnosis criteria.
Setting Hospital (multicentered). The economic study was conducted in Hamburg, Germany.
Dates to which data relate The main effectiveness data were obtained from a single study conducted in 1997. Resource and cost data were taken from 1994-1997 sources. The price year was 1994 (stated for indirect costs only).
Source of effectiveness data The estimates of incidence of attacks per patient,headache severity, hours of absence from work and "non-work" activities, productivity impairment at work and during "non-work" activities, the demand for assistance at home and medical care were obtained from a single study.
Link between effectiveness and cost data The costing was undertaken retrospectively on the same patient sample as that used in the effectiveness analysis.
Study sample Of the total 198 patients recruited, 581 migraine attacks were recorded during the run-in period and 2,039 during the 4-months treatment period. Of these, 558 and 1,978 attacks reported by 173 patients were available for comparative evaluation of the run-in and treatment periods. Overall, 168 (28 male, mean age, 44.9 +/- 10.3 years) patients were included in the analysis. The most common medication of attacks during the run-in period was: ergotamine-combination (25%), NSAID-combination (24%), DHE-combination (19%) and NSAIDS (12%). The severity categories during the run-in period were: mild 15%, moderate 44%, severe 40% and missing data 1%.
Study design This was a case-control study. A pre-test post-test comparison was used. Data from a 1-month run-in period on patients' usual treatment were compared with data from a 4-months treatment period with sumatriptan. The loss to follow-up was 8 patients in the 1-month period and 22 in the 4-months period.
Analysis of effectiveness The analysis of effectiveness was based on treatment completers only. The primary health outcomes were incidence of attacks per patient, headache severity, hours of absence from work and "non-work" activities, productivity impairment at work and during "non-work" activities, the demand for assistance at home and medical care.
Effectiveness results The average annual frequency was 35 attacks per patients. The improvements for usual treatment were 22% of patients with 6% pain-free, and for sumatriptan were 82% with 63% pain-free. During the 1-month run-in period, patients were absent from work for 72 hours per year and absent from "non-work" activities for 68 hours per year (p< 0.001 and p< 0.03). When using sumatriptan, patients were absent from work for 25 hours per year and from "non-work" activities for 28 hours per year (p<0.001 and p=0.02). During the 1-month run-in period, lost productivity at work and at outside work were 49 hours per year and 88 hours per year, respectively (p<0.001 and p=0.03). When using sumatriptan, productivity loss during attacks at work was 16 hours per year and productivity loss during non-work activities was 99 hours per year ( p=0.08). In 11.8% of all attacks, additional physician's help was necessary during the 1-month run-in period compared with 3.4% of all attacks during the treatment period. During the 1-month run-in period, the annual demand for home care was 90 hours (7% friends and 93% relatives). During the treatment period, the annual demand for home care decreased to 35 hours per year (7% friends, 91% relatives and 3% other persons) (p=<0.001 and p=0.01). The patient groups were shown to be comparable.
Clinical conclusions Treatment with sumatriptan was more effective in reducing severity of patients' migraine attack relative to their usual treatment. In addition, treatment with sumatriptan lead to significant reductions in absence from work and "non-work" activities and reduced productivity impairment at work and demand for medical and domestic assistance.
Measure of benefits used in the economic analysis The authors did not develop a summary measure of benefit. The principal benefit was expressed in terms of cost savings.
Direct costs Run-in and treatment period medical care costs and drugs were included in the analysis. The quantities were reported separately from the prices. The quantity/cost boundary adopted was the hospital. The price year was 1994. Discounting was not undertaken.
Statistical analysis of costs Indirect Costs Absence from work and "non-work" activities costs and productivity from work and "non-work" activities costs were included in the analysis. The quantities were reported separately from the prices. The quantity/cost boundary adopted was the hospital. The price year was 1994. Discounting was not undertaken.
Currency German marks (DM). The conversion rate used was DM1 = US $1.7254.
Sensitivity analysis A one-way sensitivity analysis was performed on cost factors for medical care and home care.
Estimated benefits used in the economic analysis The annual saving in terms of indirect costs was DM2,348 per migraineur. The annual saving in terms of direct costs was DM806. The reduction in indirect and direct costs by using sumatriptan were DM3,155.
Cost results The total indirect costs were DM4,807 during usual treatment and DM2,459 during sumatriptan treatment. The total direct costs were DM1,284 during the usual treatment and DM478 during sumatriptan treatment. The extra cost of using sumatriptan was DM3,155.
Synthesis of costs and benefits The total annual saving per patient was DM467 and the total annual saving per clinical outcome was DM831. An increase of elasticity factor produced an increase in the total cost difference from DM3,155 to DM3,659. The decrease of 0.6 resulted in a lower total cost difference of DM2,650.
Authors' conclusions The study shows that sumatriptan should be of significant economic benefit in helping to reduce the resource costs of migraine, particularly in patients suffering from severe attacks.
CRD COMMENTARY - Selection of comparators No single comparator was selected. The comparators were in fact the usualtreatments for migraine or no treatment during the one month period prior to switching to the intervention. You, as a user of this database, should consider whether these are widely used health technologies in your own setting.
Validity of estimate of measure of benefit The validity of the study results is questionable on the grounds that the analysis does not take into account the possibility of a placebo effect of any regular treatment, and the potential of confounding variables that might have been present during the one month before period. Furthermore, the reason for the difference in duration of the run-in period and treatment period was not given (one month before, four months after).
Validity of estimate of costs Resource quantities were reported separately from the prices. Adequate details of methods of quantity/cost estimation were given. Important cost items do not appear to have been omitted.
Other issues The issue of generalisability to other settings or countries was not addressed. However, appropriate comparisons were made with other studies, particularly in relation to mean absence from work, migraine-related events outside work and effective productivity in work and "non-work" activities. Results were tested using sensitivity analysis in order to validate the robustness of the findings.
Implications of the study The results favour the use of sumatriptan but a prospective, randomisedtrial which uses one single comparator and blinding would add greater weight to the findings of this study.
Bibliographic details Larbig W, Bruggenjurgen B. Work productivity and resource consumption among migraineurs under current treatment and during treatment with sumatriptan: an economic evaluation of acute treatment in moderate to severe migraineurs. Headache Quarterly, Current Treatment and Research 1997; 8(3): 237-246 Indexing Status Subject indexing assigned by CRD MeSH Adult; Cost-Benefit Analysis; Economics, Pharmaceutical; Female; Male; Migraine Disorders /drug therapy; Recurrence; Sumatriptan /economics /therapeutic use; Treatment Outcome; Work AccessionNumber 21997007399 Date bibliographic record published 31/05/1999 Date abstract record published 31/05/1999 |
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