Cost-Effectiveness and Cost-Utility Analysis of Cinnarizine Compared to Valproate in Pediatric Migraine: An Iranian Perspective.

OBJECTIVES: Childhood migraine is a prevalent neurovascular disease in children with a considerable reduction in quality of life and high social cost. Anticonvulsants, such as Valproate and calcium channel blockers, including Cinnarizine are used frequently as preventive medications. This research evaluates the cost-effectiveness and cost-utility of Cinnarizine versus Valproate in managing childhood migraine, based on an Iranian societal perspective. MATERIALS & METHODS: A randomized cohort trial was conducted, involving 150 children aged 5 to 17 years at the Imam Reza Clinic in Shiraz, Iran. Patients were administered Cinnarizine (1-2 mg/kg/day) or Valproate (10-20 mg/kg/day) for three months, evaluated by decision-tree models for cost-utility and cost-effectiveness. Effectiveness was measured by reduction in migraine attack frequency and Quality-Adjusted Life Years (QALYs). Costs were obtained from patient medical records, questionnaires, and national datasets, including direct and indirect costs. Sensitivity analysis, such as Monte Carlo simulations, was performed to validate the results. RESULTS: Patients receiving Cinnarizine experienced a mean QALYs of 0.213 versus 0.209 for the Valproate group and a higher rate of response at 26% (Cinnarizine) versus 14% (Valproate). Total costs during the study period favored Cinnarizine ($183 vs. $191) with an Incremental Cost Effectiveness Ratio of $-156 per additional effect and an Incremental Cost Utility Ratio of $-2069 per QALYs. Adverse effects noted were drowsiness (17.8%) for the Cinnarizine and dizziness (13.5%) for the Valproate arm. Probabilistic sensitivity analysis contained an 88.2% probability that Cinnarizine was cost-effective with a willingness-to-pay of $17,922 per QALYs. CONCLUSION: Cinnarizine was a cheaper option compared to Valproate as a prophylactic agent in pediatric migraine in Iran with higher response rates, lower expenses, and similar effectiveness. Further research with long-term follow-ups and varied populations is needed to validate the results.