Mullins C Daniel, Weis Kathleen A, Perfetto Eleanor M, Subedi Prasun R, Healey Paul J
University of Maryland School of Pharmacy, 515 W. Lombard St., 2nd Fl., Baltimore, MD 21201, USA.
J Manag Care Pharm. 2005 Jun;11(5):394-402. doi: 10.18553/jmcp.2005.11.5.394.
Managed care and other decision makers need sound comparative information to support the formulary selection process and reimbursement decisions for the treatment of migraine. The objective of this study was to compare currently marketed triptan therapies using number-needed-to-treat (NNT) and doses-needed-to-treat (DNT) measures. DNT was further used to derive triptan treatment cost to achieve 100 successfully treated patients such that the cost-effectiveness of each treatment regime could be compared from the payer perspective.
Using published meta-analysis data to categorize patients as treatment success or failure, an NNT and a DNT were derived for each triptan. Treatment success was defined as achieving a 2-hour pain response, sustained through 24 hours postdose. Costs were derived by multiplying DNT by the average wholesale price (AWP) minus 15% for each triptan.
Eletriptan 40 mg had the lowest NNT, with 361 patients needing to be treated in order to have 100 patients achieve clinical benefit; rizatriptan 5 mg had the highest NNT (597 patients). Eletriptan 40 mg required 388 doses to successfully treat 100 patients.the lowest number of doses of the triptans considered; rizatriptan 5 mg required the highest number (662 doses). Eletriptan 40 mg had the lowest total triptan cost of USD 5,630 to successfully treat 100 patients. The highest total triptan cost of treatment was USD 11,136 for naratriptan 2.5 mg.
Eletriptan 40 mg provides the best value in terms of the lowest DNT, assuming an approximately equal AWP discount for each triptan. Eletriptan 40 mg also was found to have the lowest total triptan cost to successfully treat 100 patients. Future research should further explore the utility of DNT in managed care decision making.
管理式医疗及其他决策者需要可靠的对比信息，以支持偏头痛治疗的处方选择过程及报销决策。本研究的目的是使用需治疗人数（NNT）和需治疗剂量（DNT）指标，对目前市场上销售的曲坦类疗法进行比较。进一步使用DNT得出治疗100例成功治疗患者所需的曲坦类药物治疗成本，以便从支付方角度比较每种治疗方案的成本效益。
利用已发表的荟萃分析数据将患者分类为治疗成功或失败，为每种曲坦类药物得出NNT和DNT。治疗成功定义为在给药后24小时内持续达到2小时的疼痛缓解。通过将每种曲坦类药物的DNT乘以平均批发价（AWP）减去15%来得出成本。
40毫克依立曲坦的NNT最低，为使100例患者获得临床益处，需要治疗361例患者；5毫克利扎曲坦的NNT最高（597例患者）。40毫克依立曲坦成功治疗100例患者需要388剂，是所考虑的曲坦类药物中剂量最低的；5毫克利扎曲坦所需剂量最高（662剂）。40毫克依立曲坦成功治疗100例患者的曲坦类药物总成本最低，为5630美元。2.5毫克那拉曲坦的治疗曲坦类药物总成本最高，为11136美元。
假设每种曲坦类药物的AWP折扣大致相等，40毫克依立曲坦在最低DNT方面提供了最佳价值。还发现40毫克依立曲坦成功治疗100例患者的曲坦类药物总成本最低。未来的研究应进一步探索DNT在管理式医疗决策中的效用。
