1) Evans KW, Boan AJ, Evans JL and Shuaib A . Economic evaluation
　 of oral sumatriptan compared with oral caffeine/ergotamine for
　 migraine . Pharmacoeconomics 1997; 12: 565-577

論文抄録

We conducted an economic comparison of oral sumatriptan with oral caffeine/ergotamine in the treatment of patients with migraine. Cost-effectiveness, cost-utility, and cost-benefit analyses were conducted from societal and health-department perspective. A decision tree was used. Utilities were assigned to health status using Quality of Well-Being Scale. Simple and probabilitistic sensitivity analyses were also carried out.
From a societal perspective, using sumatriptan instead of caffeine/ergotamine resulted in an incremental cost-effectiveness ratio of ? 25 Canadian Dollars ($Can) per attack aborted, an incremental cost-utility ratio of -$Can 7507 per quality-adjusted life-year(QALY), and a net economic benefit of $Can 42 per patient per year (1995 values). From the perspective of the health insurance department, the incremental cost- ratio was $Can 98 per attack aborted, the incremental cost-utility ratio was $Can 29366 per QALY; the grade of recommendation based on past decisions regarding health technology for adoption into health insurance plans was ”moderate”. Sensitivity analysis showed that results were robust to relatively large changes in the input variables.
The incremental health benefit obtained from using oral sumatriptan rather than oral caffeine/ergotamine were achieved at moderately acceptable incremental costs, if past decisions on the adoption of other health technologies are used as a guide.

エビデンスレベル

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文献タイトル ( 日本語 )

片頭痛における経口スマトリプタンと経口カフェイン / エルゴタミンとの経済評価による比較検討

目的

片頭痛における経口スマトリプタンと経口カフェイン / エルゴタミンとの経済評価による比較検討を行った．

研究デザイン

後ろ向きコホート研究・判断分析

研究施設

カナダ・サスカッチワンヘルス研究所
カナダ・レジーナ大学，カナダ政府・健康省，カナダ・サスカッチワン大学

研究期間

1995 年

対象患者

片頭痛

介入

スマトリプタン錠，カフェイン / エルゴタミン錠

主要評価項目とそれに用いた統計学的手法

１報のランダム化比較試験より判断分析に必要な確率情報 ( 臨床効果，入院率，救急室受診率 ) を入手．また， QWB(Quality of Well-Being) という効用測定を用いて，患者個人の効用 (utility) を測定した．

結果

社会的立場から，カフェイン / エルゴタミンの代わりにスマトリプタンを使用することで，発作１回抑える毎にー 25 カナダドルの増分費用対効果比が必要であり，１ QALY を得るためにー 7507 カナダドルが必要であり，年間 1 人当たり 42 カナダドルが社会に還元される結果となった．保険支払い者立場からは，発作１回抑える毎に 98 カナダドルの増分費用対効果比が必要であり，１ QALY を得るために 29366 カナダドルが必要であるという結果となった，健康保険プランに採用するための医療技術のに関する意思決定のため推奨度としては，中程度であった．感度分析の結果，組み込んだ変数が相対的に大きく変化しても，分析結果の頑健性が保たれていた．

結論

経口カフェイン / エルゴタミンよりもスマトリプタンの使用により健康的便益が増し，それは中程度の受け入れ可能な割り増し費用で達成された．

備考

MeSH Terms

作成者

清水俊彦

The aim is to confirm that sumatriptan oral, a new 5-HT1B/!D receptor agonist agent, is more cost-effective than current treatments in general patients who suffer from moderate to sever migraine attacks, and has a substantially favourable impact on the migraine treatment in Japanese society.
Cost-effectiveness, cost-utility, and cost-benefit analyses were retrospectively conducted to evaluate economic impact of sumatriptan oral using a decision tree, compared with customary treatments involving abortive and prophylaxis treatment in general patients who suffer from moderate to sever migraine attacks from the perspective of the healthcare payer and the societal viewpoint. Domestic unit cost data obtained from a local hospital in Japan were incorporated into the analyses. In addition, clinical evaluation and probabilities for the analyses were taken from domestic and overseas clinical data.
From the perspective of the healthcare payer, sumatriptan oral was expected to be approximately JPY 12,000 per migraine attack aborted cheaper than current treatments. In addition, sumatriptan oral was proven to cost approximately 3.4 million per QALY gained cheaper than current treatments.
From the societal viewpoint, sumatriptan oral was expected to be approximately JPY 28,000 per migraine attack aborted cheaper than current treatments. In addition, sumatriptan oral was expected o be approximately JPY 8.1 million per QALY gained cheaper than customary treatments. Furthermore the annual net economic benefit per patient, which is gained by sumatriptan oral, is estimated at approximately JPY 56,000.
Sensitivity analyses performed by using variables of several factors demonstrated that the base-case results are obviously reliable in clinical practice.
Sumatriptan oral for the treatment of migraine attacks was proven to be dominantly more cost-effective than customary treatments as well as to have a substantially favourable economic impact on Japanese society.

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Economic impact of oral sumatriptan in the treatment of migraine in Japan .

一回の発作を避けるために，僅か約 600 円の余計なお金を支払うだけですむ．また， 1 年間発作に悩まされず健康に暮らすためには，約 200 万円強の余計なお金を支払いことになる．しかし，余計なお金はカナダの保険償還の基準に照らし合わせると，中程度に推奨される基準に当てはまることから，スマトリプタン錠による片頭痛治療は費用対効果に優れた治療法であると考えられた．

医学中央雑誌検索語
•  スマトリプタン錠
•  経済評価
•  片頭痛
費用対効果