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Triptans for Acute Migraine: Drug Class Review to Help Inform Policy Decisions
Author(s) -
Knowles Sandra,
Oh Paul,
Gomes Tara
Publication year - 2015
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12594
Subject(s) - triptans , medicine , migraine , formulary , listing (finance) , drug class , intensive care medicine , medical emergency , drug , family medicine , business , psychiatry , finance
Background/Objective In Ontario, triptans are publicly funded through the O ntario D rug B enefit's E xceptional A ccess P rogram, a prior authorization program. However, it was unclear whether this listing aligned with current evidence of safety and effectiveness for triptans in migraine. Using a comprehensive and novel drug class review framework, we describe our review of triptans for the management of acute migraine to evaluate the appropriateness of triptan listing on the public drug formulary in O ntario. Methods This supplement in H eadache highlights four key components of the triptan drug class review, including findings from a qualitative analysis of patient and clinician perspectives, a systematic review and network meta‐analysis of clinical trial evidence, a pharmacoepidemiologic analysis comparing utilization trends across Canada, and a reimbursement‐based economic analysis. Results We found that triptans were efficacious and safe for the treatment of acute migraine. However, O ntario has among the lowest rates of publically funded triptan use in C anada, which may be due to the highly restrictive nature of access to triptans in O ntario. Expanding access to triptans via a less restrictive listing (eg, Limited Use) would potentially increase use by 20‐fold, with increase in costs of approximately 220%. Conclusion Based on findings from our multi‐faceted review and after stakeholder review and input from the Citizens' Panel, two policy options for triptans were recommended for O ntario's publically funded drug program: Limited Use access or coverage via the Exceptional Access Program, both options including quantity limits of 12 units per month.