Costs of Acute Headache Medication Use and Productivity Losses Among Patients with Migraine: Insights from Three Randomized Controlled Trials

DOI: https://doi.org/10.1007/s41669- 018- 0105- 0

Abstract-Summary By reducing the number of monthly migraine days (MMD) experienced by patients, effective preventive treatments can reduce acute medication use and costs of lost productivity.

The number of days per month on which patients used acute medication was

estimated as a function of MMD.

Zero-inflated Poisson regression models were used to predict acute medication

use and productivity losses per MMD.

The results demonstrated that as MMD increased, use of acute medication also

increased.

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The relationship of MMD to both acute headache medication use and lost pro-

ductivity was non-linear, with marginal outcomes increasing with frequency.

As MMD increased, acute medication use and productivity loss also increased,

but the relationship was non-linear.

By reducing the MMD experienced by patients, effective preventive agents may reduce the requirement for acute medication and also reduce productivity loss, which may translate into potential economic savings.

Extended: The number of days on which patients used any headache AM was

also recorded.

Zero-inflated Poisson regression models were fitted with the number of absen- teeism and presenteeism days as response variables and regressed against MMD using the covariates set described previously.

Introduction The condition is divided into episodic migraine (EM; 0–14 headache days per month [defined as 28 days]) and chronic migraine (CM; ≥ 15 headache days per month for at least 3  months, ≥ 8 of which meet the criteria for migraine and/or respond to migraine-specific treatments), and migraine classification may guide the treatment choices available to patients [320, 474, 475].

Migraine is associated with both high direct healthcare costs and indirect costs

due to lost workplace productivity [10, 50, 142, 181–374].

Migraine prevention aims to reduce the frequency, severity, and duration of attacks, which are associated with high costs to patients, employers, and healthcare systems [476, 477].

Effective preventive agents reduce the number of monthly migraine days (MMD)

and, consequently, reduce acute treatment costs and patient disability [478].

The erenumab clinical studies included endpoints which recorded the use of

acute medication (AM) and the impact of migraine on patients’ productivity.

Methods The EM studies recruited patients with 4–14 MMD and headache days, and the CM study recruited patients with ≥15 headache days, of which ≥8 were migraine days. To understand how MMD is associated with the use of AM across the cohort and duration of the studies, the reported number of days of AM use was regressed against MMD, employing a set of covariates, including age, sex, race, treatment group, prior failed preventive migraine medication status, and MMD at study baseline.

As the response variables are count data, and given the considerable proportion of patients who reported no AM use, zero-inflated Poisson regression models were determined as the most appropriate to assess two AM use outcomes independently: days on which patients reported using migraine-specific AM and days on which patients reported using non-migraine-specific AM.

Absenteeism is defined as the number of days on which a patient misses work or study altogether; presenteeism is the number of days on which productivity is reduced by at least 50% (but not qualifying as absenteeism days).

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Results A patient experiencing 8 MMD is predicted to use migraine-specific AM on 2.82 (95% confidence interval [CI] 2.80–2.85) days and non-migraine-specific AM on 2.75 (95% CI 2.74–2.77) days per month.

A patient with CM experiencing 18 MMD is predicted to use migraine-specific AM on 7.06 (95% CI 7.01–7.12) days and non-migraine-specific AM on 4.81 (95% CI 4.79–4.84) days per month.

The results indicate a greater use of AM per migraine day for patients with

higher MMD.

A patient experiencing 8 MMD is predicted to have 0.95 (95% CI 0.94–0.96)

absenteeism days and 2.34 (95% CI 2.32–2.35) presenteeism days per month.

A patient with CM with 18 MMD is predicted to have 1.86 (95% CI 1.85–1.87)

absenteeism days and 5.18 (95% CI 5.15–5.21) presenteeism days per month.

Discussion The zero-inflated regression models applied here account for the proportions of patients in the clinical studies who reported no AM use or productivity losses.

By lowering the MMD of patients, migraine preventives may reduce lost produc-

tive time and the requirement for AM.

As these relationships are non-linear, considering only mean MMD in economic evaluations may misrepresent outcomes of patient cohorts as the impact of each additional migraine day is not constant.

MIDAS data from the clinical studies only capture workplace productivity losses among employed patients, who can quantify the number of work days impacted by their migraines.

Productivity losses of patients with migraine could be underestimated in this

study, especially for those with higher MMD.

To the MMD reduction, active treatment with erenumab may impact the severity and duration of migraines, which may also impact productivity losses and AM use compared with placebo.

Acknowledgement A machine generated summary based on the work of Porter, Joshua K.; Di Tanna, Gian Luca; Lipton, Richard B.; Sapra, Sandhya; Villa, Guillermo. 2018  in PharmacoEconomics—Open.

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Machine generated keywords: headache service, service, model, solution, primary care, neurologist, tertiary, clinic, tertiary care, brain, ltb, specialist, healthcare sys- tem, doctor, specialty.

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Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and Description