The comparators presented in have been deemed to be appropriate by clinical experts. Comparators may be recommended (appropriate) practice, versus actual practice. Comparators are not restricted to drugs, but may be devices or procedures. Costs are manufacturer list prices, unless otherwise specified. Existing product listing agreements are not reflected in the table and as such may not represent the actual costs to public drug plans.
Table 7CADTH Cost Comparison Table for Prophylaxis of Chronic Migraine (Medications with Migraine Prophylaxis Indication)
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| Drug/Comparator | Strength | Dosage Form | Price ($) | Recommended Dose | Average Daily Drug Cost ($) | Average Annual Drug Cost ($) |
|---|
| OnabotulinumtoxinA (Botox) | 50 U 100 U 200 U | Injection vial | 178.5000 357.0000 714.0000 | 155 U to 195 U every 12 weeksa | 8.47b | 2,856 to 3,570b |
| Comparators indicated for prophylaxis of migraine |
|---|
| Pizotyline/Pizotifenc,d (Sandomigran) | 1.0 mg | Tablet | 0.7735 | 1.5 mg to 4 mg per dayc,d 1.5 mg to 6 mg per daye | 1.16 to 3.09 1.16 to 4.64 | 424 to 1,130 424 to 1,695 |
| Topiramatec,d (generics) | 25 mg 100 mg 200 mg | Tablet | 0.2433 0.4583 0.6748 | 50 mg to 200 mg per dayc,d 50 mg twice per dayf | 0.49 to 0.67 0.97 | 178 to 246 355 |
| Flunarizinec,d (generics) | 5 mg | Capsule | 0.7348 | 10 mg per dayc,d,g | 1.47 | 537 |
| Erenumab | 70 mg | Pre-filled syringe for injection | 532.0000h | 70 mg to 140 mg monthlyi | 17.48 to 34.96 | 6,384 to 12,768 |
Note: All prices are from the Ontario Drug Benefit Formulary (accessed January 2019) unless otherwise indicated and do not include dispensing fees.
- a
Product monograph states that: “The use of one vial for more than one patient is not recommended because the product and diluent do not contain a preservative.”2 Thus, wastage has been included for onabotulinumtoxinA in this table.
- b
The daily cost is based on the following calculation (= [714.00 × (52 weeks/12-weekly injections)]/365.25 days). The annual cost range is based on 4 or 5 courses of injections in a year.
- c
Source: 2012 Canadian Headache Society Guideline for Migraine Prophylaxis.7
- d
Source: CPhA Therapeutic Choices: Medications for Migraine Prophylaxis12 (accessed January 3, 2019).
- e
Source: Sandomigran product monograph.13
- f
Source: Apo-Topiramate product monograph.14
- g
Source: Flunarizine product monograph.15
- h
Wholesale acquisition price based on IQVIA DeltaPA database16 (accessed January 3, 2019).
- i
Source: Aimovig product monograph.17
Table 8CADTH Cost Comparison Table for Prophylaxis of Chronic Migraine (Off-Label Medications)
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| Drug/Comparator | Strength | Dosage Form | Price ($) | Recommended Dose | Average Daily Drug Cost ($) | Average Annual Drug Cost ($) |
|---|
| Anti-epileptics |
|---|
| Divalproex Sodiuma,b (generics) | 125 mg 250 mg 500 mg | Enteric tablet | 0.0724 0.1301 0.2604 | 500 mg to 1,500 mg per daya,b | 0.26 to 0.78 | 95 to 285 |
| Gabapentina (generics) | 100 mg 300 mg 400 mg | Capsule | 0.0416 0.1012 0.1206 | 1,200 mg to 1,800 mg per daya | 0.36 to 0.56 | 132 to 206 |
| Valproatea,b (generics) | 250 mg / 5 mL | Oral solution | 0.199 | 500 mg to 1,500 mg per daya,b | 0.40 to 1.19 | 145 to 436 |
| Antidepressants |
|---|
| Amitriptylinea,b (Elavil) | 10 mg 25 mg 50 mg | Tablet | 0.0435 0.0829 0.1540 | 20 mg to 150 mg per daya,b | 0.09 to 0.46 | 32 to 169 |
| Doxepinb (generic) | 10 mg 25 mg 50 mg 75 mg 100 mg | Capsule | 0.2397 0.2940 0.5455 0.8066 1.3438 | 25 mg to 100 mg per dayb | 0.29 to 1.09 | 107 to 398 |
| Nortriptylinea (generic) | 10 mg 25 mg | Capsule | 0.2570 0.5193 | 20 mg to 150 mg per dayb | 0.51 to 3.89 | 188 to 1,408 |
| Venlafaxinea,b (generics) | 37.5 mg 75 mg 150 mg | ER capsule | 0.0913 0.1825 0.1927 | 150 mg per daya,b | 0.19 | 70 |
| Antihypertensives |
|---|
| Atenololb (generics) | 50 mg 100 mg | Tablet | 0.1107 0.1821 | 100 to 150 mg per dayb | 0.18 to 0.27 | 67 to 100 |
| Propranolola,b (generics) | 10 mg 20 mg 40 mg 80 mg | Tablet | 0.0689 0.1107 0.1225 0.2034 | 80 mg to 160 mg per daya,b | 0.20 to 0.40 | 74 to 149 |
| Nadolola,b (generics) | 40 mg 80 mg 160 mg | Tablet | 0.4512 0.3710 1.2046 | 80 mg to 160 mg per daya,b | 0.37 to 0.74 | 136 to 271 |
| Metoprolola,b (generics) | 50 mg 100 mg | Tablet | 0.0624 0.1361 | 100 mg to 200 mg per daya,b | 0.14 to 0.27 | 50 to 99 |
100 mg 200 mg | SR tablet | 0.1415 0.2568 | 0.14 to 0.26 | 52 to 94 |
| Verapamila,b (generics) | 80 mg 120 mg | Tablet | 0.2735 0.4250 | 80 mg three to four times dailya,b | 0.82 to 1.09 | 300 to 400 |
120 mg 180 mg 240 mg | SR tablet | 0.5078c 0.5204 0.5075 | 240 mg to 320 mg per day divided in two dosesa,b | 0.51 to 0.78d | 185 to 285 |
| Candesartana (generics) | 4 mg 8 mg 16 mg 32 mg | Tablet | 0.1700 0.2281 0.2281 0.2281 | 16 mg per daya | 0.28 | 83 |
| Lisinoprila (generics) | 5 mg 10 mg 20 mg | Tablet | 0.1347 0.1619 0.1945 | 20 mg per daya | 0.19 | 71 |
| Anti-manic |
|---|
| Lithium carbonateb (generics) | 150 mg 300 mg | Capsule | 0.0667 0.0657 | 300 mg three times dailyb | 0.20 | 72 |
ER = extended release; SR = sustained release.
Note: All prices are from the Ontario Drug Benefit Formulary (accessed January 2019) unless otherwise indicated and do not include dispensing fees.
- a
Source: 2012 Canadian Headache Society Guideline for Migraine Prophylaxis.7
- b
Source: CPhA Therapeutic Choices: Medications for Migraine Prophylaxis12 (accessed January 3, 2019).
- c
Source: Saskatchewan Online Formulary Database18 (February 2019).
- d
The maximum daily cost is for the 320 mg per day dosage. As combinations of existing sustained-release formulations (120 mg, 180 mg, and 240 mg) do not add up to 320 mg dose; a 240 mg sustained release tablet and 80 mg standard tablet was assumed.
