Economic burden of migraine in Latvia and Lithuania: direct and indirect costs

DOI: https://doi.org/10.1186/s12889- 019- 7461- 2

Abstract-Summary This study aims at estimating the economic cost of migraine in Latvia and Lithuania, including both direct and indirect costs.

Direct costs encompass the costs of migraine-related health care resource

utilization.

Indirect costs are related to productivity loss, the potential or expected earnings

lost due to migraine.

The prevalence rate of migraine and the migraine-related health care resource utilization are proxied from the literature, whereas unit cost of medical services and procedures are retrieved from national databases and providers.

For estimating the indirect cost of migraine, we follow the human capital

approach.

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We find that the mean per-person total cost of migraine is €801 annually in

Latvia, and €721 in Lithuania.

In both countries around 30% of total cost is direct cost; cost related to a wide

array of migraine-related medical services and interventions.

The total cost of migraine is €112.26 million in Latvia, corresponding to 0.42%

of Latvia’s GDP.

The total cost of migraine is €149.62 million in Lithuania, corresponding to

0.35% of Lithuania’s GDP.

Improvements in care for patients with migraine, such as easier access to struc- tured headache assessment services, wider availability of various procedures and preventive medications would significantly increase direct costs.

This cost increase might be far outweighed by lower migraine-related productiv- ity loss, especially as the prevalence of migraine is the highest in the most produc- tive years of life.

Extended: Direct costs encompass the cost of a wide array of migraine-related medical services and procedures: consultations with doctors, hospitalizations, emergency room visits, diagnostic testing, and medications.

Indirect costs are related to productivity loss caused by reduced labour force

participation, absence from work, and reduced productivity while at work.

The prevalence rate is estimated by identifying systematic reviews on migraine

prevalence from a systematic review of the literature in PubMed and Scopus.

The prevalence rate of 11.4% estimated by Woldeamanuel and Cowan [358] for Europe involving a sample size of 808,749 participants is used in further analysis as a conservative estimate.

For estimating the direct cost of migraine in Latvia and Lithuania, first migraine-

related health care resource utilization is proxied by relying on previous literature.

Background Migraine sufferers use health care resources more often than individuals without migraine; they visit their general practitioners more frequently, they typically con- sult a neurologist about their headaches and several diagnostic tests are performed to rule out other causes of migraine symptoms.

Costs associated with migraine-related health care resource utilization are

labelled as direct costs.

This study aims at estimating the economic cost of migraine in Latvia and

Lithuania.

No study so far has assessed the economic cost of migraine in Latvia, while one study has examined the cost of migraine in Lithuania as part of the Eurolight proj- ect [13].

The productivity losses associated with migraine are significant, the indirect cost of migraine is considered to be far more important than direct costs [13, 203, 376]. To estimate indirect cost for employed migraineurs, we consider that the entire annual gross income is lost; this income could have been earned had the individual lived without disabling migraine.

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Economics

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Methods For estimating the direct cost of migraine in Latvia and Lithuania, first migraine- related health care resource utilization is proxied by relying on previous literature.

We perform a systematic literature review to arrive at a reliable prevalence rate estimate for Latvia and Lithuania; meta-analysis estimates combining the findings of several European studies on migraine prevalence are preferred over single- country estimates.

For estimating the direct cost of migraine in Latvia and Lithuania, first migraine-

related health care resource utilization shall be estimated.

A targeted literature review produced a number of valuable studies; in this sub- section these studies are reviewed briefly with the aim of identifying the most rele- vant source to estimate the migraine-related health care resource utilization in Latvia and Lithuania.

Stewart and others [377] report estimates on absenteeism for migraine sufferers

participating in the AMPP study in 2005 in the US.

Results Mean per-person annual costs of migraine is €205.77  in Latvia, and €177.73  in Lithuania.

In Latvia total cost of migraine-related health care resource utilization is €28.83

million, corresponding to 0.11% of Latvia’s GDP in 2017 [378].

In Lithuania total cost of migraine-related health care resource utilization is

€36.87 million, corresponding to 0.09% of Lithuania’s GDP in 2017 [379].

In Lithuania the total productivity loss incurred through unemployed migraine sufferers is €12.51 million, corresponding to 0.03% of Lithuania’s GDP in 2017 [379].

Total productivity cost, considering both employed and unemployed migraineurs,

is €83.43 million in Latvia, and €112.75 million in Lithuania.

The mean per-person total cost of migraine is €801.37 annually in Latvia, and

€721.24 in Lithuania.

Discussion We document much higher mean per-person annual total cost of migraine in both Baltic countries: €801 in Latvia, and €721 in Lithuania.

For Lithuania, the total cost of migraine reported in this study is in line with the

total cost estimate in [13].

Linde and others [13] find that the total cost of migraine in Lithuania is €139.74 million, derived as the product of the per person mean annual cost and the number of migraine sufferers (N = 469,998).

As we have no information from surveys on how much migraine sufferers exactly spend on medications relieving their pain, we relied on a number of assumptions to arrive at a mean per patient medication cost estimate for Latvia and Lithuania.

Unless a survey among migraineurs is carried out, we cannot validate the annual

mean per patient medication cost estimate used in this study.

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Conclusions We found that mean per-person total cost of migraine is €801 annually in Latvia, and €721 in Lithuania.

Mean per-person direct cost is €206 in Latvia and €178 in Lithuania. Mean per-person indirect cost for unemployed migraineurs is €11,111 in Latvia,

and €10,085 in Lithuania; this cost is related to reduced workforce participation.

Mean per-person indirect cost for employed migraineurs is €564 in Latvia, and €521 in Lithuania, this cost is related to absenteeism and impairment while at work. The total cost of migraine is €112.26 million in Latvia, corresponding to 0.42%

of Latvia’s GDP.

The total cost of migraine is €149.62 million in Lithuania, corresponding to

0.35% of Lithuania’s GDP.

Acknowledgement A machine generated summary based on the work of Lublóy, Ágnes. 2019 in BMC Public Health.

Burden and costs of migraine in a Swedish defined patient population—a questionnaire- based study