Healthcare resource utilization and direct costs associated with frequent nausea in episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study

Richard B Lipton, Dawn C Buse, Jane Saiers, Daniel Serrano, Michael L Reed
Journal of Medical Economics 2013, 16 (4): 490-9

BACKGROUND: Nausea is a common migraine symptom that is associated with impaired quality-of-life and functional disability. In this study, population-based data were used to elucidate the relationship between nausea frequency and headache-related healthcare utilization and costs in persons with migraine.

RESEARCH DESIGN AND METHODS: Participants with episodic migraine who completed the 2009 American Migraine Prevalence and Prevention (AMPP) Study survey rated their headache-related nausea as occurring never, rarely, <half the time, or ≥half the time with their headaches, and completed questions on symptom frequency and healthcare resource utilization.

MAIN OUTCOME MEASURES: Ordinal logistic regression models were used to assess the association between nausea frequency and headache-related healthcare utilization. Healthcare cost equivalents were calculated.

RESULTS: Among the 6488 respondents with episodic migraine, the number of respondents observed across headache-related nausea frequency strata were 6.9% for never, 14.5% for rarely, 29.1% for <half the time, and 49.5% for ≥half the time. In unadjusted models, the odds of having ≥1 healthcare encounter for headache in the preceding year increased with frequency of nausea for primary care/obstetrics-gynecology visits (OR = 1.41; 95% CI = 1.30-1.52, p < 0.001), nurse practitioner/physician assistant visits (OR = 1.52; 95% CI = 1.25-1.85, p < 0.001), neurology/headache clinic visits (OR = 1.33, 95% CI = 1.18-1.51, p < 0.001), pain clinic visits (OR = 1.31, 95% CI = 1.01-1.71, p < 0.05), emergency department visits (OR = 1.85; 95% CI = 1.56-2.19, p < 0.01), and overnight hospital stays (OR = 1.50, 92% CI = 1.12-2.00, p < 0.01). The odds of having ≥1 lifetime CT scan or MRI also increased with the frequency of nausea (p < 0.001 for both). Results remained significant in these analyses when controlling for sociodemographics and overall symptom severity except in the case of pain clinic visits (p < 0.107). Visits for Mental Health and visits for Chiropractic/Alternative care did not differ significantly by nausea group in unadjusted or adjusted models. Mean estimated direct headache-related healthcare cost equivalents per person per year generally increased with increasing headache-related nausea frequency across categories of healthcare utilization. Average per person healthcare cost for nausea ≥half the time vs nausea never was $179 and $49 yearly for outpatient services, $183 vs $20 yearly for overnight hospital stays, and $314 vs $257 for lifetime diagnostic services/imaging.

CONCLUSIONS: Direct costs of migraine increase with increasing frequency of migraine-associated nausea. Both frequency and severity of headache-related nausea should be monitored as part of ongoing care of persons with migraine. Headache-related nausea, like headache pain, should be considered an area of central concern during clinical, diagnostic, and treatment optimization assessments.

STUDY LIMITATIONS: This study relied on self-reported headache frequency and healthcare costs which are subject to recall bias and under-reporting; however, reporting bias is unlikely to be different as a function of nausea frequency. In addition, medication use costs and indirect costs (which may be higher than direct costs for migraine) were not assessed.

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