Twenty times as many migraine sufferers in Ontario could get some relief if the government broadened access to an effective group of drugs known as triptans

Almost one in 10 Ontarians suffer from migraines every year but just 1,200 patients receive public coverage for medication to manage the most debilitating headaches. Researchers at the Institute for Clinical Evaluative Sciences (ICES) and St. Michael’s Hospital are recommending expanded access to triptans in Ontario.

Triptans are a class of drugs used for acute treatment of migraine headaches.

The large drug class review was conducted by the Ontario Drug Policy Research Network (ODPRN) and appears today in the journal Headache.

“Our review shows that triptans work to effectively manage migraine headaches, but strict provincial regulations mean that few patients who could benefit from these drugs are able to get them through the public system. However, unlike other provinces, Ontario doesn’t limit the quantity for patients who do receive triptans through the public drug program, which means these patients may be at a higher risk of medication overuse headaches, and that leads us to recommend changes to the current program,” says Tara Gomes, an author on the review and scientist with ICES.

The researchers recommend expanded access to triptans in Ontario to address accessibility issues identified in their earlier qualitative analysis of interviews with patients and providers, while imposing quantity limits that would reduce the risk of medication overuse headaches.

“Our review shows that people with migraines would have much easier and safer access to these drugs, with only marginal cost increases if the government expanded access to these drugs while limiting the number of doses a person could receive at one time. Less restrictive reimbursement policies  on triptans could potentially increase accessibility 20-fold, from 1,200 patients to 25,000 patients with a three-fold increase in annual costs, from $1.8 million to $5.6 million,” says Gomes, also a scientist at the Li Ka Shing Knowledge Institute of  St. Michael’s Hospital and a principal investigator of the ODPRN.

The drug class review includes four studies which found:

• Triptans are efficacious and safe for treatment of acute migraine, with many patients noting that these drugs help restore daily functionality and the ability to work.
• Affordability of triptans was a key concern impacting access, especially for patients who are low-income and/or do not have private drug coverage.
• Triptan prescribing and volume of use for public drug coverage varied significantly between provinces, the lowest rates observed in Ontario (4 per 10,000) and the highest in Manitoba (100 per 10,000).
• Under the existing reimbursement system, approximately one in 10 triptan users eligible for public drug plan coverage in Ontario was prescribed quantities of triptans that might place them at risk of medication overuse headaches.

The drug class review includes a systematic review of the efficacy and safety of these drugs, a qualitative analysis of patient and healthcare provider perspectives, an environmental scan of how these drugs are covered in other jurisdictions, a pharmacoepidemiologic study of how public funding status impacts accessibility and potential risks of these drugs, and a budget impact analysis of various potential policy options.

“Access to triptans for acute episodic migraine: a qualitative study,” was published today in Headache.

Author block: Sobia Khan, Alekhya Mascarenhas, Julia E. Moore, Sandra Knowles and Tara Gomes.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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