P RACTICE I NSIGHTS Cost-Benefit Analysis of Sumatriptan Tablets versus Usual Therapy for Treatment of Migraine Andrea K. Biddle, M.P.H., Ph.D., Ya-Chen Tina Shih, Ph.D., and W. Jacqueline Kwong, Pharm.D. We performed a systematic assessment of the costs and benefits of sumatriptan and usual therapy for migraine from society’s perspective. A decision tree was constructed with probability estimates based on data from an open-label clinical trial assessing the economic and human impacts of sumatriptan and usual therapy on nursing personnel. Direct medical care costs including costs for drug, physician, and emergency room visits were considered. Benefits were estimated using the human capital approach based on the national average of weekly earnings and productivity loss estimated from a migraine clinical trial. The net benefits of sumatriptan and usual therapy for the treatment of a single migraine attack were estimated to be $50 and $20, respectively. The annual incremental net benefit of sumatriptan over usual therapy was estimated to be $114–540/patient. The price difference was offset by benefits of sumatriptan in reducing use of health care resources and productivity loss. (Pharmacotherapy 2000;20(11):1356–1364) Migraine is an episodic headache characterized by recurrent attacks that may vary in pain intensity, duration, and frequency. The headache can be mild to severe and is aggravated by activity. Migraine also can be associated with other symptoms such as nausea, vomiting, photophobia, and phonophobia. In a study conducted with a representative sample of the United States population in 1989, 17.6% of women and 5.7% of men had one or more migraine headaches/year. 1 Because the disorder is most prevalent in persons between 25 and 44 years of age, 2 the disabling symptoms cause losses of productivity and output to society. The economic and human burdens of migraine are reported in the literature. In a survey study conducted in a sample of migraineurs who had participated in a clinical trial assessing the efficacy of sumatriptan (Imitrex; Glaxo Wellcome, Research Triangle Park, NC), it was estimated that the 648 respondents used a total of $529,199/year in health care services based on self-reported resource use and lost labor. 3 The extrapolated cost of productivity loss to employers was $5.6–17.2 billion for the U.S. work force. In another survey study assessing health-related quality of life using the Short Form-36 Health Survey, migraineurs had significantly lower scores than age- and sex- adjusted U.S. norms for individuals without chronic illness. 4 The goals of treatment are to alleviate symptoms of migraine attacks and to prevent further attacks. For the past decade, several serotonin (5-HT 1 ) agonists (triptans) have been marketed in the U.S. for the treatment of migraine. In clinical studies this class of agents was significantly better than placebo in reducing From the Department of Health Policy and Administration, School of Public Health (Drs. Biddle and Kwong), and the Division of Pharmaceutical Policy and Evaluative Sciences, School of Pharmacy (Dr. Shih), University of North Carolina, Chapel Hill, North Carolina; MEDTAP International Inc., Bethesda, Maryland (Dr. Shih); and U.S. Medical Affairs Health Outcomes, Glaxo Wellcome Inc., Research Triangle Park, North Carolina (Dr. Kwong). Address reprint requests to Andrea K. Biddle, Ph.D., Department of Health Policy and Administration, University of North Carolina at Chapel Hill, CB #7400, Chapel Hill, NC 27599-7400.