SUMATRIPTAN TOO COSTLY FOR UK NHS?

Two recent reports in the British Medical Journal and The Lancet on the acute treatment of migraine have drawn attention to what many perceive as an important question: can the UK National Health Service afford the new and expensive drugs emerging from the industry research pipeline?

There is little doubt that the economic impact of the condition is enormous in terms of lost work days, reduced performance and costs of treatment. At the moment this is reckoned to be in the region of L 150-L 300 million annually, with just L 23 million of this cost borne by the NHS. As a contrast to this low figure, the BMJ points out that if 10% of the UK population have an average of one migraine attack per month, "a new acute therapy achieving 100% market penetration at L 20 per treated attack would cost L 1.344 billion."

Glaxo's 5-HT1 agonist Imigran (sumatriptan) could qualify as an example of such a radical new treatment. It clearly represents an important advance over existing treatments such as analgesics, anti-emetics and ergotamine, and on the basis of efficacy it is likely to capture a large market share very quickly. What is worrying to the NHS and others who will pick up the bill for the treatment, is that the significant number of patients who currently self-medicate for their attacks because of disenchantment with what their doctors have to offer them, will switch to use of sumatriptan, reflecting the inadequacy of the older over-the-counter treatments.