Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States.

OBJECTIVE: The goal of this analysis was to provide a contemporary estimate of the burden of migraine, incorporating both direct and indirect costs, by comparing the costs of migraine patients to a matched group of patients without migraine in a large, nationally representative sample of commercially insured patients in the United States.

BACKGROUND: Previous studies have shown that the economic burden of migraine in the United States is substantial for payers, patients, and employers. Despite the availability of multiple acute and preventive pharmacological treatment options and a relatively stable migraine prevalence in the United States, there has been a documented increase in migraine-related healthcare resource and pharmacy use. Given the frequently disabling nature of migraine and its high prevalence, especially during peak productive years, and the lack of recent estimates of the burden of migraine, there is a need to update the existing literature with more current data.

METHODS: This retrospective, observational cohort study identified migraine patients in the Truven Health Market Scan Research Databases between January 2008 and June 2013. Adult patients had 12 months of continuous enrollment before (baseline period) and after (follow-up period) the day they received migraine diagnoses and/or medications (index) and no diagnosis of HIV or malignancy during the study period. The patients with migraine were matched 1:1 to a group of patients without migraine on demographic variables and index date. Direct healthcare utilization and costs and indirect (absenteeism, short-term disability, and long-term disability) costs were assessed during the 12-month follow-up period and differences between patients with vs without migraine were assessed. Two additional multivariable logistic regression analyses were conducted. First, an analysis was conducted comparing the odds of having a short-term disability claim between patients with and without migraine after controlling for patient demographic and clinical characteristics. A second analysis, conducted among the migraine patients only, compared the odds of having a short-term disability claim between (1) patients treated with acute or preventive migraine medications only during the baseline period and patients with no migraine treatment during baseline and (2) patients treated with both acute and preventive migraine medications during the baseline period and patients with no migraine treatment during baseline, after controlling for patient demographic and clinical characteristics.

RESULTS: Migraine patients had total annual direct plus indirect costs that were $8924 (in 2014 United States dollars) higher than those of demographically similar individuals without evidence of migraine. Migraine patients' mean annual direct all-cause healthcare costs were $6575 higher than those of matched patients without migraine ($11,010 [standard deviation = $19,663] vs $4436 [standard deviation=$13,081]; P < .01). Total mean annual indirect costs were $2350 higher in the migraine cohort than in the matched no migraine patients ($11,294 vs $8945. Migraine patients were 2.0 times more likely as their nonmigraine counterparts to use opioids (45.5% vs 21.9%; P < .01) and among patients with opioid prescriptions, migraine patients had 1.8 times the number of opioid prescriptions per patient than did those without migraine (4.9 [standard deviation = 6.9] vs 2.7 [standard deviation = 4.0]; P < .01). After adjusting for baseline demographic and clinical characteristics, migraine patients treated with either acute or preventive migraine medications (odds ratio = 0.81 [95% confidence interval = 0.72-0.91]; P < .01) or both acute and preventive migraine medications during the baseline period (odds ratio = 0.93 [95% confidence interval = 0.89-0.98]; P < .01) were significantly less likely to have short-term disability claims than untreated patients during the follow-up period (Migraine patients with either acute or preventive medications only: 7290/45,632 [16.0%]; with both acute and preventive medications: 3085/14,941 [20.6%]; untreated patients: 1604/11,169 [14.4%] had a short-term disability claim.) However, overall, migraine patients had 1.94 times the odds of having a short-term disability claim than their matched counterparts (95% confidence interval = 1.83-2.05; P < .01; migraine patients: 11,979/71,742 [16.7%]; nonmigraine patients: 4801/71,742 [6.7%] had a short-term disability claim).

CONCLUSIONS: Results from this real-world assessment of the economic burden of migraine suggest that migraine imposes a substantial direct and indirect cost burden in the United States. Compared to matched nonmigraine patients, migraine patients were more likely to have work loss and longer periods of work loss, leading to significantly higher indirect costs. Migraine patients also had higher levels of healthcare utilization, despite the relatively stable prevalence of migraine and the available acute and preventive treatment options for migraine management.