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

DOI: https://doi.org/10.1186/s10194- 019- 1015- y

Abstract-Summary Migraine leads to an extensive socio-economic burden in terms of healthcare costs, reduced workforce and quality of life (QoL) but studies of the health-economic consequences in a Swedish context are lacking.

The objective of this study is to map the health-economic consequences of migraine in a defined patient population in terms of healthcare consumption, pro- duction loss and QoL in Sweden.

The results are presented in yearly costs per patient and losses in quality adjusted

life years (QALYs).

The total cost per patient and year increased with the number of migraine days per month (p < 0.001) and varied between approximately €5000 for those with less than 3 migraine days per month and €24,000 per year for those with 21–28 migraine days per month.

The average loss in QALYs per year also increased with the monthly number of

migraine days (p = 0.023).

Migraine leads to significant societal costs and loss of quality of life. There appears to be an unmet need and a potential for both cost savings and QoL

benefits connected with a reduction in the number of migraine days.

Extended: The results are presented by number of migraine days per month using

the following categories; 0, 1–3, 4–5, 6–7, 8–9, 10–14, 15–20 and 21–28 days.

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The results are in the upper range of results reported in a previous European study by Bloudek and others 2012, covering data from the UK, France, Germany, Italy and Spain [172], which might be explained by our study almost only including persons with a physician’s diagnosis, while Bloudek and others included a large amount of self-diagnosed persons.

Background Of the disease burden of migraine in Sweden, people with migraine had on average 1.3 migraine episodes per month, which lasted for 19 h on average [380].

Several studies have shown that migraine leads to an extensive socio-economic burden in terms of direct costs, i.e. resources required for health care and treatment [172], indirect costs, i.e. the value of the lost production resulting from migraine- related absenteeism and presenteeism (reduced productivity at work related to migraine) [11, 13] and reduced quality of life (QoL) [11, 381–384].

An earlier European study has reported yearly health care costs related to migraine between € 500 and 3700 per person depending on country and migraine frequency [172].

The average societal cost of migraine in eight European countries has previously been reported to more than € 1200 per person and year where production loss accounted for the main part [13].

The primary objective of this study was to map the health-economic conse- quences of migraine in a defined patient population in terms of healthcare consump- tion, production loss and QoL in Sweden based on a survey of people with migraine.

Method The web-based questionnaire was designed to include questions about age, gender, migraine duration, migraine frequency, diagnoses, number of visits to physicians and visits to other healthcare providers due to migraine, acute drug treatment and preventive drug treatment, sickness absence and QoL. QoL was measured by the generic instrument, Euro-Qol 5 dimensions—5 levels (EQ-5D-5  L) [385], and a disease-specific instrument, HIT-6 (Headache Impact Test) [386].

Depending on the response, the respondent was instructed to recall their last day with/without migraine and again respond to questions on the health status of that day using EQ-5D-5 L. The number of health care visits and the use of preventive drug treatment were asked with a 12 month recall period while acute drug treatment and sickness absence were asked with a 4 week recall period.

The production loss due to long-term work absenteeism was based on the assumption that respondents with migraine and long-term sick-leave would have had the same productivity as the general population (of corresponding age and sex) if they would have been free of migraine.

Results More than half of respondents had a migraine episode lasting less than 24 h. 52.9% of the respondents reported that last 4  weeks corresponded to an average month regarding migraine frequency, 30.4% reported it as a “better” month than average, and 14.3% that the last month was “worse” than an average month.

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The respondents had reported 22 days of sick leave during the last 12 months. The average total cost per patient and year for respondents with chronic migraine (defined as at least 15 headache days per month, whereof at least 8  days with migraine) was almost three times higher compared to the average total cost per patient and year for respondents with episodic migraine (€21,782 vs. €7598, p < 0.001).

The total average loss in QALYs per person and year was 0.10 and significantly higher for respondents with chronic migraine compared to respondents with epi- sodic migraine (0.25 vs. 0.06, p < 0.001).

Discussion This study is retrospective, i.e. respondents reported migraine experience, resource consumption and QoL for a period back in time.

There might also be a risk of bias in the QoL calculation as the reporting of both observable and retrospective EQ-5D might magnify the difference between the ictal and interictal phases, i.e. people might underestimate their QoL at the last attack compared to the current non-migraine day.

In the UK study, people with migraine retrospectively completed EQ-5D for dif- ferent levels of severity during one single migraine episode resulting in a loss in QoL of 0.21 for mild migraine, 0.34 for moderate migraine and 1.07 for severe migraine.

In the UK study, the respondents assessed their QoL at a time of the migraine

episode when feeling the worst.

Respondents reported QoL during a whole migraine episode.

Conclusions Both costs and loss in quality of life increases with the number of migraine days.

There is potential for both cost savings and quality of life benefits connected with

a reduction in the number of headache and migraine days.

Acknowledgement A machine generated summary based on the work of Hjalte, Frida; Olofsson, Sara; Persson, Ulf; Linde, Mattias. 2019 in The Journal of Headache and Pain.

A universal outcome measure for headache treatments, care- delivery systems and economic analysis