Cost of chronic and episodic migraine patients in continuous treatment for two years in a tertiary level headache Centre

DOI: https://doi.org/10.1186/s10194- 019- 1068- y

Abstract-Summary Available data suggest that migraine is world widely associated with a high eco- nomic burden, but there is great variability in estimated costs that depends on the geographical, methodological and temporal differences between the studies.

The purpose of this study was to quantify the annual direct cost of episodic migraine (EM) and chronic migraine (CM), both for the patient and for the National Health System (NHS), using data from subjects who attended an Italian tertiary headache centre.

Our sample consisted of 548 patients (85.4% women and 14.6% men): 65.5%

had CM and 34.5% had EM.

The average annual expenditure per patient was €1482. The main item of expenditure were medications that represented 86.8% (€1286), followed by specialist visits (10.2%), hospitalizations for (1.9%), diagnostic tests for (1%) and ED visits for (0.1%).

Costs were significantly higher for women than men (€1517 vs. €1274, p = 0.013)

and increased with age (p = 0.002).

The annual direct cost of CM was 4.8-fold higher than that of EM (€2037 vs.

€427, p = 0.001).

Our results provide a valuable estimate of the annual direct cost of CM and EM patients in the specific setting of a tertiary headache centre and confirm the high economic impact of migraine on both the NHS and patients.

Extended: The purpose of this study was to quantify and compare the annual direct cost of EM and CM, both for the patient and for the National Health System (NHS), using the data of subjects attending an Italian tertiary level headache centre. The average annual expenditure per patient was €1482 and the variability of expenditure per patient was high, the spending range of was between €51 and €3644, with an inter-quartile difference of €1666 (€511 - €2177) and a coefficient of variation (standard deviation on the arithmetic mean) of the 58.3%.

The main item of expenditure was represented by medications that represented 86.8% (€1286), followed by specialist visits for 10.2% (€153), hospitalizations for 1.9% (€28), diagnostic tests for 1% (€15) and ED visits for 0.1% (€1).

We believe that the methodology used in our study is a step forward compared to the annualization of data based on self-administered questionnaires for the previous 3–4 months.

Governments and decision makers should strongly support these investigations to reveal the true economic and social impact of migraine, particularly when it is chronic.

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1 Public Health

Introduction The third edition of the International Classification of Headache Disorders (ICHD-3) sets the threshold for differentiating episodic migraine (EM) from chronic migraine (CM) at 15 days per month in the last 3 months [20].

Migraine also has an important economic burden on patients and society. “. It is yet not possible to precisely quantify the direct costs of migraine [373]. The available data suggest that CM is widely associated with a higher economic burden than EM, but there is a large variability in estimated costs that depends on the geographical, methodological and temporal differences between the studies [13–172, 374].

The purpose of this study was to quantify and compare the annual direct cost of EM and CM, both for the patient and for the National Health System (NHS), using the data of subjects attending an Italian tertiary level headache centre.

We comparatively evaluated the impact of gender and age on the economic bur-

den of migraine.

Methods The data used for the current economic analysis come from a retrospective and non- interventional observational analysis of the electronic medical records (EMR) of all subjects with EM and CM (assessed with the ICHD-3 [20]) who consecutively attended our tertiary level headache centre and who were in continuous treatment and underwent follow-up visits in the 2 years prior to 31 January 2019 (data collec- tion date).

The data collected included demographic characteristics, number of specialist visits, number of diagnostic tests (echocardiogram, carotid color doppler, brain / cervical magnetic resonance, brain computed tomography, radiographs, blood tests), number of accesses in the emergency department (ED), days of hospitaliza- tion due to the pathology and consumption of medications (acute and preventives). Demographic and clinical characteristics, number of specialist visits, number of diagnostic tests, number of ED visits, days of hospitalization, and consumption of drugs (reimbursed and not reimbursed by the NHS) were evaluated descriptively.

Results The diagnostic tests had an average cost per patient of €15, covered by the NHS for 80% (€12).

The mean annual cost for the NHS relating to the hospital management of

patients in terms of days of hospitalization was €28 per patient.

As preventive medications, patients with CM used more antidepressants (p = 0.000) and anxiolytics (p < 0.0001) while EM patients used more nutraceutics (p < 0.0001).

Among acute medications, CM patients used more NSAIDs (p  < 0.0001) and simple analgesics (p = 0.020) while patients with EM used more triptans (p = 0.035) and combination analgesics (p < 0.0001).

The overall mean annual cost of medications was €1286 per patient, of which the

85.1% accounted for preventive treatments.

1.3

Economics

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Discussion Our study provides a specific quantification of the annual direct cost associated with CM and EM (assessed with the ICHD-3 [20]) based on gender and age of patients in a large population of subjects attending an Italian tertiary level headache centre. A systematic review used the preliminary data provided by the Eurolight group, and therefore different from those subsequently published for the Eurolight study, and estimated in €222 (in 2009 Euros) the total annual (direct + indirect) cost per patient in Italy (in seven other European countries in the range between €111 and €649) [375].

Our estimate of direct costs is lower (€1482) and this could depend on the differ-

ent population studied (CM and EM vs. CM and MOH).

Conclusions Our results provide a valuable estimate of the annual direct cost of patients with CM and EM in the specific setting of a tertiary level headache centre and confirm the high economic impact of migraine on both the NHS and patients.

Patients with CM have had more visits, diagnostic tests and drug use than patients

with EM, which led to a direct annual cost of 4.8 times that of EM.

Costs were significantly higher for women than for men and increased with age.

Acknowledgement A machine generated summary based on the work of Negro, Andrea; Sciattella, Paolo; Rossi, Daniele; Guglielmetti, Martina; Martelletti, Paolo; Mennini, Francesco Saverio. 2019 in The Journal of Headache and Pain.

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