Patients’ perspective on the burden of migraine in Europe: a cross-sectional analysis of survey data in France, Germany, Italy, Spain, and the United Kingdom

DOI: https://doi.org/10.1186/s10194- 018- 0907- 6

Abstract-Summary This study aimed to characterize the incremental burden of migraine in individuals who suffer from ≥4 monthly headache days (MHDs) by examining health-related quality of life (HRQoL), impairments to work productivity and daily activities, and healthcare resource utilization (HRU) in the EU5 (France, Germany, Italy, Spain, United Kingdom).

Short-Form 36-Item Health Survey, version 2 (SF-36v2) physical and mental component summary scores (PCS and MCS), Short-form-6D (SF-6D), and EuroQoL (EQ-5D), impairments to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire (WPAI), and HRU were compared between migraine respondents suffering from ≥4 MHDs (n = 218) and non-migraine con- trols (n  =  218) by propensity score matching using sociodemographic characteristics.

HRQoL was lower in migraine individuals suffering from ≥4 MHDs compared with non-migraine controls, with reduced SF-36v2 PCS (46.00 vs 50.51) and MCS (37.69 vs 44.82), SF-6D health state utility score (0.62 vs 0.71), and EQ-5D score (0.68 vs 0.81) (for all, p < 0.001).

Respondents with migraine suffering from ≥4 MHDs also reported higher levels of absenteeism from work (14.43% vs 9.46%; p = 0.001), presenteeism (35.52% vs 20.97%), overall work impairment (38.70% vs 23.27%), and activity impairment (44.17% vs 27.75%) than non-migraine controls (for all, p < 0.001).

Consistently, migraine subgroups (4–7 MHDs, 8–14 MHDs and CM) had lower HRQoL, greater overall work and activity impairment, and higher HRU compared to non-migraine controls.

Migraine of ≥4 MHDs was associated with poorer HRQoL, greater work pro-

ductivity loss, and higher HRU compared with non-migraine controls.

Background Migraine was the sixth leading cause of disability-adjusted life years (DALYs) worldwide for the age group 25 to 39 years in the 2015 Global Burden of Disease (GBD) study [170].

1.2

Personal and Societal Burden

55

The GBD 2016 study reported migraine as the first leading cause of years lived with disability (YLDs) worldwide in both males and females for the age group 15 to 49 years, demonstrating that the burden is higher in the groups of prime produc- tivity [47].

The primary objective of this study was to characterize the incremental burden of migraine in those experiencing ≥4 MHDs from patients’ perspective in terms of HRQoL, work and activity impairment, and HRU compared with non-migraine controls among the EU5.

The secondary objective was to characterize the burden of migraine from the perspective of migraine patients experiencing ≥4 MHDs from the EU5 by frequency of migraine (eg, 4–7, 8–14, and ≥ 15 MHDs) compared with non-migraine controls. Methods Of the 16,340 survey respondents who reported experiencing migraine in the past 12 months, a randomly selected subsample of 1680 respondents (10%) completed the migraine module with additional questions on migraine characteristics and of these, 771 respondents reported a physician-diagnosed migraine.

The study sample (respondents who self-reported a physician-diagnosis of migraine) who completed the migraine module and indicated that they experienced migraines of at least 4 MHDs were matched by propensity scores to those without migraines (controls) using sociodemographic characteristics (see below).

As the objective of the study was to estimate the incremental burden associated with migraine, the propensity score of respondents with migraine was compared with that of those without migraine (controls) using demographic and comorbidi- ties data.

This procedure was conducted separately within each country and for those with 4–7 EM, 8–14 EM, and CM to limit the risk that respondents differ from controls on matching characteristics within the smaller migraine subgroups.

Results 6 months before completion of questionnaire, the mean number of total HCP visits (8.5 vs 5.1; p  <  0.001) and ED visits (0.46 vs 0.21; p  =  0.011) reported by the migraine sample were significantly higher than non-migraine controls.

A significantly higher proportion of migraine respondents compared with non- migraine controls had at least one visit to a general/family practitioner (77.1% vs 67.4%; p = 0.025), neurologist (13.8% vs 3.7%; p < 0.001), and psychiatrist (13.3% vs. 3.2%; p < 0.001) in the prior 6 months.

Discussion The analysis showed that after propensity score matching of the subgroups based on demographic and health characteristics, those suffering from migraine of at least 4 MHDs had significantly lower HRQoL, increased work and activity impairment, and higher HRU than their non-migraine matched controls.

The present study showed higher levels of absenteeism (1.5-fold), presenteeism (1.7-fold), work productivity impairment (1.7-fold), and activity impairment

56

1 Public Health

(1.6- fold) in those suffering from at least 4 MHDs compared with non-migraine matched controls.

These findings are consistent with previous studies in Europe and the US con- ducted in the overall migraine population where ED visits, hospitalizations, and medicines are among the major cost drivers, while the presence of certain symptoms and/or comorbidities leads to further increase in direct costs [10, 171, 172]; as the frequency and severity of migraine increased, the HRU and economic impact to the healthcare system also increased.

Conclusions The findings of the current study reveal that there is an incremental burden due to migraine on HRQoL (mental, physical, and health status), work productivity (both presenteeism and absenteeism), and the utilization of healthcare resources among those who suffer from migraine ≥4 MHDs in comparison to the matched non- migraine controls in the EU5.

Migraine is undertreated as the patients did not have access to appropriate health- care, suggesting that effective management and preventive treatments are needed to lessen the frequency and burden of migraine.

Acknowledgement A machine generated summary based on the work of Vo, Pamela; Fang, Juanzhi; Bilitou, Aikaterini; Laflamme, Annik K.; Gupta, Shaloo. 2018  in The Journal of Headache and Pain.

My migraine voice survey: a global study of disease burden among individuals with migraine for whom preventive treatments have failed