Migraine treatment - a financial headache
Summary
More than 70 million people worldwide suffer from migraines, yet despite the dramatic effects on everyday life that migraine sufferers face, new research from Datamonitor has revealed that due to economic constraints within national healthcare systems, some patients aren't getting the best available treatment.A migraine is a primary neurobiological disorder, which manifests itself as recurring attacks, usually lasting from four to 72 hours. An estimated 5-12% of the global population is classified as suffering from migraine, some 74 million people in the seven major pharmaceutical markets, while between 23% and 42% of migraineurs report more than 24 attacks in the previous 12 months.
Inadequate treatment options
Migraine attacks, which can interfere greatly with the everyday lives of sufferers, involve unilateral throbbing headache pain of moderate to severe intensity and usually involve nausea, sometimes vomiting, and/or photo and phonophobia (sensitivity to light and sound).
Despite these figures, approximately half of all migraineurs do not seek medical advice, and of those who do, only 3-19% are prescribed triptans. The most commonly used current treatment are simple analgesics like Excedrin, which are used by 20-50% of patients, but current migraine treatment is only effective in 20-30% of patients. Not surprisingly only 20-50% of patients are satisfied with their current treatment.
Although the triptan class is considered the well-established cornerstone of migraine therapy, there is a significant delay between patient's first experience of migraine symptoms and triptan use. First-line therapy predominantly utilizes simple analgesics and non-steriodal anti-inflammatory drugs (NSAIDs), despite the lack of sustained anti-migraine effect seen with these products and the risk of rebound headaches. By educating both primary care providers (PCPs) and patients alike, the growth in the wider and earlier use of the triptan class will be accelerated.
Generic impact
Despite the fact that triptans are not always prescribed as first line treatment, (mostly for economic rather than medical reasons) opinion leaders spoken to by Datamonitor remain convinced they are the most effective medication. Comments included, "Triptans are the most efficacious drugs without any doubt. You can use them via several routes, which is also very important in clinical practice; via a nasal, mouth intake or even via the mouth with a wafer formulation, or subcutaneous." Another stated: "All my patients, or 99% of my patients are given a triptan option."
However, the good news for patients is that the use of triptans may soon be accelerated by the arrival of generics onto the market. Oral forms of GlaxoSmithKline's sumatriptan (the first triptan released on the market and still the top seller in the class) are expected to lose patent protection from 2006 and 2009 in the EU and US, respectively. It is inevitable that these cheaper generics will take market share from the more expensive, branded triptans.
A cheaper, generic triptan would allow more migraine sufferers access to the best available medication, however it is something of an indictment on modern healthcare services that they are not as widely used as possible already. While pragmatism has to dictate healthcare expenditure to a certain extent, given the dramatic effect migraine has on the everyday lives of sufferers, one could make a reasonable argument that they should get the best available medication.
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