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Triptans reduce lost worktime for migraine

Clinical bottom line

The total time lost to usual activities during a single migraine attack was reduced from 9 hours with placebo treatment to 4 hours with eletriptan. The total work time lost fell from 4 to 2.5 hours.


Migraine attacks usually mean that sufferers are unable to carry out those functions, both activities of daily living and paid employment, that they would normally do. Results from a randomised trial [1] put some numbers on how much of that lost time can be regained by using an effective triptan.

Study

A large multinational randomised controlled trial compared treatment with eletriptan 40 mg (followed by a further dose of 40 mg if headache had not been reduced to at least mild intensity by two hours), eletriptan 80 mg plus 80 mg if needed, and placebo followed by placebo. Eletriptan is an effective migraine treatment at these doses, with equivalent NNTs to other triptans (though a review is still awaited, and eletriptan has yet to be launched as of March 2001).

Patients filled in a brief questionnaire after the first attack of migraine. It asked about how long (to the nearest half hour) the patient had been unable to undertake usual activities )at home, work, or elsewhere) that they would normally have undertaken. This was defined as total time loss. They also responded to a question about time in paid employment and how much time was lost because of the migraine attack (through arriving late, leaving early, absence, or resting at work).

Results

Patients were aged at least 18, and 84% were women. There were 692 patients in the three groups with loss of time data. Evaluable for total loss of time were 674 responses, and for work loss time 244 responses. This reflected the fact that many did not experience an attack whilst at work.

The total time lost with placebo (Figure 1) was a median of 9 hours. This reflected a very wide distribution. For example, while half of the patients lost fewer than 9 hours, at least 60 patients lost more than 20 hours. The mean value was 14.5 hours of total time lost.

Figure 1: Total time lost with a single migraine attack with placebo

The total time lost with either dose of eletriptan was 4 hours (mean about 7 hours, Figure 2 for 40 mg eletriptan). The distribution was very different with eletriptan, with only a small proportion losing more than 9 hours.

Figure 2: Total time lost with a single migraine attack with eletriptan 40mg

Median work time lost with placebo was 4.0 hours. It was 2.5 hours with 40 mg eletriptan and 3.0 hours with 80 mg eletriptan .

Thus for each migraine attack, treatment with an effective dose of a triptan, with use of a further dose if the first fails to provide adequate relief, will result in a saving of a median of five hours of total time, and 1-1.5 hours of work time.

Economic costs

Multiplying the median savings in work time with the gross hourly wages in the UK would suggest an economic gain of £12.50 per attack for a triptan compared with placebo. Other calculations based on total time lost suggest that a gain of £31 per attack could be imputed.

Comment

The economic consequences of migraine is fertile territory for dispute. It has been argued that time lost at work because of migraine is made up later, or may be put off for another day. That may be the case, but experience suggests that the consequences of illness to small, tightly run organisations cannot be lightly dismissed.

In any event, this detailed analysis of total time lost to everyday activities is important because it demonstrates just how much time can be lost because of migraine if untreated. The impact in personal terms is much bigger than the impact in statistical terms.

Reference:

1 NE Wells, TJ Steiner. Effectiveness of eletriptan in reducing time loss caused by migraine attacks. Pharmacoeconomics 2001 18: 557-566.