Meta-analysis of oral triptan therapy for migraine: number needed to treat and relative cost to achieve relief within 2 hours

J Manag Care Pharm. 2003 Jan-Feb;9(1):45-52. doi: 10.18553/jmcp.2003.9.1.45.


Objective: To determine the cost-effectiveness of the 5-HT1B/1D agonists, or triptans, in the acute treatment of migraine.

Methods: To determine the cost-effectiveness of the triptans, a meta-analysis was conducted of the efficacy data from 27 oral triptan trials, using the endpoint of "pain-free" status within 2 hours after initial dosing as the indicator of efficacy. Efficacy data were used to determine the number needed to treat (NNT) to achieve pain-free status in 1 patient within 2 hours postdose and then applied the per-dose costs for each triptan to the NNT values.

Results: Rizatriptan 10 mg and almotriptan 12.5 mg were the most cost-effective of the triptans, costing $48.34 and $48.57 US dollars, respectively, to achieve pain-free status in 1 patient within 2 hours postdose. Frovatriptan 2.5 mg was the most costly, with a cost-effective ratio of $162.49 US dollars. All other triptans fell between these extremes: zolmitriptan 5 mg ($65.18 US dollars), sumatriptan 100 mg ($70.83 US dollars), sumatriptan 50 mg ($75.67 US dollars), zolmitriptan 2.5 mg ($78.74 US dollars), and naratriptan 2.5 mg ($141.43 US dollars), in decreasing order of cost-effectiveness.

Conclusion: Using an NNT analysis, the least-costly drugs to achieve migraine cure within 2 hours are rizatriptan 10 mg and almotriptan 12.5 mg. From a population health perspective, the lower acquisition cost of almotriptan 12.5 mg allows for effective treatment of more patients than rizatriptan 10 mg for no additional medication cost.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Cost-Benefit Analysis
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Male
  • Migraine Disorders / drug therapy*
  • Randomized Controlled Trials as Topic
  • Serotonin Receptor Agonists* / administration & dosage
  • Serotonin Receptor Agonists* / economics
  • Serotonin Receptor Agonists* / therapeutic use
  • Sumatriptan / administration & dosage
  • Sumatriptan / economics
  • Sumatriptan / therapeutic use
  • Triazoles / administration & dosage
  • Triazoles / economics
  • Triazoles / therapeutic use
  • Tryptamines


  • Serotonin Receptor Agonists
  • Triazoles
  • Tryptamines
  • rizatriptan
  • Sumatriptan