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Medical Costs, Lost Productivity Are Substantial for Chronic Migraine

VBCN - April 2016 Volume 3, No 1 - Migraine
Wayne Kuznar

The annual direct medical costs of patients with chronic migraine approach $5000, and the costs associated with lost productivity exceed $3000 annually. The total cost for chronic migraine is more than 3 times that for episodic migraine, according to researchers who conducted the International Burden of Migraine Study.

The study confirms that “costs associated both with headache-related medical resource use and lost productive time were substantially greater in persons with CM [chronic migraine] than with EM [episodic migraine],” wrote Andrew Messali, PharmD, PhD, University of Southern California, Los Angeles, and Consultant, Allergan plc, Irvine, CA, and colleagues (Messali A, et al. Headache. 2016;56:306-322).

The investigators assessed data related to the burden of migraine illness from 1205 US participants in the first International Burden of Migraine Study, a 2-phase, web-based, cross-sectional panel survey conducted in 10 countries. The participants in the survey were asked to report their recent headache-related use of services and medications during the previous 3 months.

The study participants were divided into episodic migraine and chronic migraine groups, based on the reported number of monthly headache days. The vast majority (91.3%) of the participants had episodic migraine. The direct and indirect costs were estimated by applying the estimated unit costs to the reported headache-related productivity losses and resource use.

Healthcare resource utilization was greater among participants with chronic migraine than among those with episodic migraine. Of patients with chronic migraine, 29.1% reported visiting a primary care physician compared with 14.4% in patients with episodic migraine (P <.001). Significantly more participants with chronic migraine also reported visiting a neurologist or a headache specialist, nurse practitioners or physician assistants, and other health professionals.

Some 9.7% of patients with chronic migraine reported receiving headache-related diagnostic testing within the 3 months before the survey was completed compared with 3.7% of the patients with episodic migraine (P = .009). The patients with chronic migraine spent $83.29 on diagnostic imaging compared with $26.73 for patients with episodic migraine (P <.005).

The patients with chronic migraine were estimated to spend more on primary care visits than patients with episodic migraine ($45.26 vs $25.49, respectively; P <.037), more on neurologist or headache specialist visits ($39.69 vs $11.92, respectively; P <.0097), and more on other specialty visits ($60.61 vs $16.53, respectively; P <.002) over the previous 3 months.

Prophylactic medicines cost patients with chronic migraine $163.10, and acute medicines cost them $157.80, which is significantly more than the $16.13 and $34.74, respectively, that was spent by patients with episodic migraine (P <.001).

The mean total annual cost of headache in chronic migraine was more than triple that of episodic migraine ($8243 vs $2649, respectively; P <.001). The direct annual medical cost was $4943 for chronic migraine, which was significantly higher than the $1705 for episodic migraine (P <.001). In addition, the indirect productivity cost was higher for patients with chronic migraine than for patients with episodic migraine ($3300 vs $943, respectively; P <.001).

“Because of the high headache frequency in people with CM, these individuals cannot miss work each time they have a migraine attack,” Dr Messali and colleagues pointed out. “Instead, results indicate that although full-time workers with CM miss a mean of only 1.8 days over 3 months due to their headaches, they spend about a quarter of their days at work (15.7 days over 3 months) operating at 50% capacity or less.”

Full-time workers with episodic migraine missed an average of 0.8 days over 3 months and spent approximately 5% of their days at work (3.3 days over 3 months) operating at 50% capacity or less. “It is important to recognize this difference, because employers may otherwise assume that, because employees are present at work, productivity is not impacted,” the investigators emphasized.

“Only 49.5% of CM participants in this study were employed full- or part-time, compared to 60.5% of EM participants, suggesting some CM-related unemployment or occupational disability as well as underemployment,” they added.

The mean costs associated with absenteeism and presenteeism were $323 and $1425, respectively, among full-time working patients with chronic migraine, which were significantly higher than the $150 (P = .004) and $296 (P <.001), respectively, that were associated with patients with episodic migraine who worked full time. Similar cost differences were found between patients with chronic migraine and episodic migraine who worked part time.

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