Cost of migraine prevention with topiramate medicines

Abstract

Introduction. According to the World Health Organization, migraine is one of the 20 diseases that limit a person's life the most. The first-line medicines of choice for the preventive therapy of migraine, which are recognized as effective based on clinical data, include valproic acid and its salts, topiramate, metoprolol, propranolol, and timolol. Materials and methods. Data from information and reference and scientific literature, information fund "State Register of Medicinal Products of Ukraine" (SRMPU), information and search site tabletki.ua. Research methods - webometric, comparative analyses, data systematization, pharmacoeconomic analysis (cost minimization). Research results. According to the guidelines of the American Academy of Neurology, topiramate is an effective treatment for migraine prevention (level of evidence A), significantly reducing the frequency and severity of migraine attacks. The recommended dose range is 25-50 mg. After analyzing the data presented in the SRMPU, it was established that as of October 2023, 14 trade names of topiramate were registered on the pharmaceutical market of Ukraine, taking into account the medicinal form, dosage, and manufacturer. The original topiramate in a dose of 25 mg - Topamax costs more in pharmacies than generic analogues. A comparative analysis of the cost of generic medicines shows that the cost of 1 tablet of imported medicine is 1.16 times cheaper than domestic medicines. Topiramin is cheaper in pharmacies - UAH 8.16, the average cost of 1 tablet (the price ranges from UAH 7.58 to UAH 8.74); the highest average cost of 1 capsule Topamax is UAH 17.23 (from UAH 14.14 to UAH 20.32). However, the average cost of 1 package of Topiramine is more expensive, since the packaging - 60 tablets covered with a shell in a bottle, and the drug Topiromax - 10 tablets in a blister, 3 blisters in a cardboard pack (30 tablets ...) and Topamax - 28 capsules in a bottle are cheaper for 1 package. There is only the original Topamax for 50 mg of topiramate, the average cost of 1 capsule is UAH 23.74 (the price varies from UAH 21.69 to UAH 25.79). To analyze the cost of preventive therapy lasting 1 month, taking into account the information from the officially approved instructions for the medical use of topiramate, dosages of 25 and 50 mg of selected medicines. Film-coated tablets of 100 mg are not divisible, so they cannot be used twice a day. It`s established the cost of the one month of preventive therapy with topiramate: - Topamax, 50 mg – UAH 1,424.40; - Topamax, 25 mg – UAH 2,067.60; - Topiramine, 25 mg – UAH 979.20; - Topiromax 25 – UAH 1,137.60. Therefore, the cheapest for patients to carry out preventive therapy will be the imported generic medicine Topiramine - 60 coated tablets in a bottle of 25 mg, and the most expensive for the original drug in the form of Topamax capsules of 25 mg (2.1 times compared to Topiramine). Conclusions: In the instructions for all topiramate medicines registered in Ukraine, it is indicated that the it is used in adults for the preventive therapy of migraine. On the pharmaceutical market of Ukraine, topiramate is available in the form of capsules (original imported medicine) and film-coated tablets (generic medicines) of domestic and imported production. It has been established that on the pharmaceutical market, in particular in pharmacies of the city of Lviv: - Among topiramate medicines in a dosage of 25 mg, the least expensive is 1 tablet coated with Topiramin, produced in Canada; the most expensive is the Topamax capsule, produced in Italy/USA. - topiramate 50 mg is available only in the form of capsules - Topamax, average cost - UAH 23.74. The cost of one month (30 days) of preventive therapy in accordance with the recommendations of the officially approved instructions for the medical use of topiramate (50 mg twice a day) is from UAH 979.20 (Topiramin 25 mg) to UAH 2,067.60 (Topamax 25 mg each).

Keywords: migraine prevention, cost,  topiramate