Epidemiology, work and economic impact of migraine in a large hospital cohort: time to raise awareness and promote sustainability

DOI: https://doi.org/10.1007/s00415- 021- 10715- 2

Abstract-Summary Migraine is not routinely assessed at work, making impossible to realize its impact and the potential benefit of migraine-related health strategies.

We aimed to assess epidemiology, work and economic impact of migraine in a

workplace cohort of a tertiary hospital.

Through a web questionnaire, we screened participants for migraine, collecting demographic data, work characteristics, work impairment due to headache (WPAI), treatments and healthcare resource utilization.

Migraine caused an overall economic loss for the hospital of 439,848.90 €/ month, as a result of utilization of healthcare resources at the workplace (136,028.0 €/month) and indirect costs (absenteeism + presenteeism: 303,820.90 €/month).

Only 110 participants (HFEM + CM) were responsible for half of indirect costs

(165,017.2€/month).

Although healthcare professionals have greater knowledge on health issues, migraine is underdiagnosed and undertreated, leading to a significant economic loss for the hospital.

These results urge companies to assess migraine and promote stronger and migraine-specific health strategies at the workplace as a way to improve their own economic sustainability and the burden of migraine in their workforce.

Extended: Future studies should also aim to evaluate different work settings, the cost–benefit effects of health strategies and their translation in terms of employees’ wellbeing and companies’ sustainability.

Adequate strategies to correctly diagnose, treat and prevent migraine should be promoted in the near future within every hospital or company as a way to improve economic sustainability.

Introduction Migraine has enormous costs for society.

In the European Union, for example, the total annual cost of migraine was esti-

mated at €111 billion [13].

At a national level, several studies have estimated global migraine costs and sav- ings [14, 15], whereas in companies employers have not been able to promote com- prehensive evaluations of migraine economic impact at work, with limited data available at present [16–19].

In hospitals, for example, healthcare resources may be directly used at work- place, adding direct costs to the indirect ones and generating an even higher eco- nomic impact.

We decided to describe and quantify epidemiology, working and economic

impact of migraine in a workplace cohort of a Spanish tertiary hospital.

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1 Public Health

Methods Through a structured questionnaire based on the International Classification of Headache Disorders—3 (ICHD-3) [20] criteria, we screened participants for migraine and tension-type headache (TTH).

We collected data about headache frequency, acute medication intake and pre-

ventive treatments currently used.

We also asked participants about all complementary tests performed due to head-

ache in this time frame.

We assessed migraine impact through Headache Impact Test (HIT-6) [21] and specifically working impact through Work Productivity and Activity Impairment Questionnaire (WPAI) [22].

We used the WPAI to estimate work time loss (absenteeism) and work impair-

ment (presenteeism).

Absenteeism cost (€/month): MHW8 (work hours/day) 5 (work days/week) percentage of work time loss/week due to headache (time lost/time lost + time worked) 4 (weeks/month).

Presenteeism cost (€/month): MHW productivity loss in a migraine day while working [(Work time  −  work time loss)/work time) * Productivity Impairment (from WPAI)] headache monthly frequency.

We assessed statistical significance between migraine subdiagnoses (LFEM,

HFEM and CM) by Pearson’s Chi-square when comparing categorical variables.

Results In participants with migraine, 76.8% (365/475) had low-frequency episodic migraine (LFEM: < 10 headache days/month), 12.6% (60/475) high-frequency epi- sodic migraine (HFEM: 10–14 headache days/month) and 10.5% (50/475) chronic migraine (CM: > 14 days/month).

Work time loss (absenteeism) due to headache in the last seven days was reported by 14.7% (70/475) of participants, resulting in a percentage of work time missed/ week of 6.7% [16.6] for LFEM, 8.1% [18.1] for HFEM, 7.9% [65.7] for CM.

Eighty point four percent (382/475) reported impairment at work (presenteeism) due to headache in the last seven days, resulting in a percentage of work productiv- ity loss of 8.8% [11.7] for LFEM, 21.4% [16.0] for HFEM, 34.4% [33.3] for CM.

Discussion Our study describes the migraine “status quo” in a hospital workplace cohort, observing a monthly economic impact of 439,848.90 €/month (indirect costs + healthcare resource utilization at workplace) for the hospital, translating higher monthly cost per patient than the one estimated by national-based surveys [23].

In terms of direct costs, migraine-specific acute medications, such as triptans, could potentially reduce healthcare resource utilization in those who respond [24], representing a saving strategy for hospitals since healthcare resources are directly used by employees at workplace.

Our focus was to show migraine-related costs and impact in a specific setting, rather than in the general population, providing a model for company leaders to evaluate the work and economic impact of migraine in their workforce, in line with the Plan of Action promoted by the WHO on Workers’ Health [25].

1.1

Epidemiology

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Conclusions Migraine strikingly impacts hospital economy, as a result of employees’ global pro- ductivity loss (absenteeism + presenteeism).

The direct use of healthcare resources by employees at workplace generates

direct costs that weight on as added costs for the hospital.

Acknowledgement A machine generated summary based on the work of Caronna, Edoardo; Gallardo, Victor José; Alpuente, Alicia; Torres-Ferrus, Marta; Pozo-Rosich, Patricia. 2021 in Journal of Neurology.

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