Study Summary: Costs Associated With Migraine in the United States

Background

Migraine is a common neurological disease. Globally, it is the third most common disease and the sixth most disabling disease. In the United States, approximately 1 in 7 adults and 1 in 5 of those in their peak employment years (aged 18 to 54 years) report severe headaches or migraine in the past 3 months. Study results have shown that the use of prophylactic migraine medications decreases patients’ use of medical resources and, consequently, overall healthcare costs. Similarly, use of preventive migraine therapies reduces migraine-related productivity losses (indirect costs). However, despite availability of such medications for migraine, and a fairly stable migraine prevalence in the United States, use of healthcare and pharmacy resources among patients with this disease is on the rise. In addition, preventive migraine therapies remain underused in clinical practice.¹

The economic burden of migraine in the United States is substantial. People who experience migraine have increased healthcare use (direct costs) and decreased productivity (indirect costs) compared with those who do not have migraine. The direct costs of migraine are related to medical costs, including those of acute migraine-specific medications and the cost of managing conditions, such as anxiety and depression, that are often comorbid with migraine. In contrast, the indirect costs of migraine are associated with lost productivity, due to absenteeism, short-term disability, and long-term disability, for example. In 2016, these direct and indirect costs amounted to an estimated total annual cost of $36 billion.¹

In their study, Bonafede and colleagues sought to provide an up-to-date estimate of the total cost of migraine in the United States, to better inform employers, health plans, healthcare providers, and policy makers of the true burden of this debilitating disease.¹

Study Design

The researchers conducted a retrospective observational cohort study. Using information from a large US commercial claims database, they compared the direct and indirect costs of patients with migraine to those of a matched group of demographically similar patients without migraine, from January 2008 through June 2013.¹

For the migraine cohort, the researchers included patients who met at least 1 of 4 criteria that indicated migraine: at least 1 inpatient (IP) or emergency room (ER) claim with a migraine diagnosis; at least 2 outpatient (OP) claims (7-180 days apart) with a migraine diagnosis; at least 1 OP claim with a migraine diagnosis and at least 1 OP pharmacy claim for a triptan, ergot, or topiramate (7-180 days apart); and/or at least 2 OP pharmacy claims for a triptan or ergot (7-180 days apart). For the control cohort, they included patients who had no medical claims with a diagnosis of migraine and no OP pharmacy claims for a triptan, ergot, or topiramate. The researchers excluded patients who had received a diagnosis of HIV or any malignant neoplasm (except of the skin) during baseline (the 12-month period before receiving their migraine diagnosis) or follow-up (the 12-month period after receiving their migraine diagnosis) or if they were pregnant or gave birth during follow-up.¹

For the study’s outcome measures, Bonafede and colleagues evaluated direct healthcare use and costs as well as indirect costs (absenteeism, short-term disability, and long-term disability) during a 12-month follow-up period. They also investigated how these measures differed between patients with and without migraine.¹

In addition, they performed 2 multivariable logistic regression analyses, in which they controlled for patients’ demographic and clinical characteristics. These analyses compared the odds of having a short-term disability claim during the follow-up period for patients with and without migraine and for migraine patients who were or were not receiving acute or preventive medications.¹

Results

The study sample comprised 12,642 pairs of matched patients with workplace absence eligibility; 71,742 pairs with short-term disability eligibility; and 66,587 pairs with long-term disability eligibility.¹

According to Bonafede and colleagues, total annual mean costs for patients with migraine were $8924 greater than those of patients without migraine. As shown in the Table, direct healthcare costs for patients with migraine accounted for approximately three-quarters of this total cost and were $6575 greater than those of patients without migraine. Of this $6,575, 47% was for OP services, 26% was for OP medications, 20% was for IP services, and 7% was for ER services (Table). For example, patients with migraine were 3 times more likely to have an IP admission and more than twice as likely to make an ER visit. Each year, these patients also made significantly more physician office visits and had significantly more pharmacy claims (Table).¹

Patients with migraine also had indirect costs that were $2350 higher than those of patients without migraine ($11,294 vs $8945). This was largely attributed to the fact that patients with migraine missed almost 9 more days of work each year than their counterparts without migraine.¹

Overall, after adjusting for baseline and clinical characteristics, patients with migraine were almost twice as likely as patients without migraine to have a short-term disability claim (95% CI, 1.83-2.05; P <.01).¹ However, patients with migraine who received either acute or preventive medications (odds ratio [OR], 0.81; 95% CI, 0.72-0.91; P <.01) or both acute and preventive medications (OR, 0.93; 95% CI, 0.89-0.98; P <.01) during the baseline period were significantly less likely than untreated patients to have short-term disability claims during the follow-up period.¹

The researchers reported that long-term disability was rare in patients with and without migraine. However, those with migraine were still 2.4 times more likely (0.61% vs 0.25%; P <.01) to have a long-term disability claim.¹

Conclusions

This real-world assessment highlights the substantial productivity losses in Americans who experience migraine and provides the most recent estimate of the economic burden of this disease in the United States.¹

Bonafede and colleagues also noted that although migraine prevalence has remained stable and many acute and preventive medications are available, the estimated direct and indirect costs of migraine in this study are greater than those reported by similar studies a decade ago. They stressed that this indicates that optimal therapies for migraine are lacking.¹

The authors concluded that further research in this area should investigate factors such as the underlying causes of the rising cost burden of migraine, how the severity of migraine affects the overall burden of this disease, and how migraine treatment adherence affects healthcare use and costs.¹

Reference

1. Bonafede M, Sapra S, Shah N, Tepper S, Cappell K, Desai P. Direct and indirect healthcare resource utilization and costs among migraine patients in the United States [published online February 15, 2018]. Headache. doi: 10.1111/head.13275.