The Humanistic and Economic Burden of Migraine in Europe: A Cross-Sectional Survey in Five Countries

DOI: https://doi.org/10.1007/s40120- 020- 00196- 2

Abstract-Summary Prior studies have estimated the burden of migraine in patients suffering from ≥ 4 monthly headache days (MHDs), but the burden experienced by migraineurs suffer- ing from one to three (1–3) MHDs is unknown.

The aim of this study was to examine the incremental burden of migraine in terms of health-related quality of life (HRQoL), impairments to work and daily activities, and healthcare resource utilization (HRU) in five European countries (France, Germany, Italy, Spain, and the UK (EU5]), by comparing migraineurs with ≥ 4 MHDs and migraineurs with 1–3 MHDs.

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The Short-Form 12-Item Health Survey Instrument, version-2 physical and men- tal component summary (PCS and MCS) scores, Short-Form 6-dimensions (SF-6D), EuroQoL 5-dimensions (EQ-5D) and EuroQoL visual analog scale (VAS) scores, impairments to work productivity and daily activities (Work Productivity and Activity Impairment [WPAI] Questionnaire) scores, and HRU were compared between migraineur groups with ≥ 4 MHDs (4–7, intermediate-frequency episodic migraine; 8–14, high-frequency episodic migraine; ≥ 15 chronic migraine) and the migraineur subgroup with 1–3 MHDs (low-frequency episodic migraine) using generalized linear modeling after adjusting for covariates.

Migraineurs with ≥ 15 MHDs had significantly lower HRQoL and increased

WPAI scores and HRU than the 1–3 MHDs subgroup.

This study provides evidence supporting the incremental burden of migraine, characterized by poorer HRQoL and increased WPAI scores and greater HRU, among migraineurs experiencing ≥ 4 MHDs compared with migraineurs experienc- ing 1–3 MHDs in the EU5.

Introduction Differences in the burden of migraine between those with episodic migraine and those with chronic migraine have been reported earlier [11, 372], but only limited data are available on the burden of migraine as a function of the frequency of head- ache days, particularly among those with one to three MHDs (1–3 MHDs).

The burden of migraine experienced by those with intermediate-frequency epi- sodic (4–7 MHDs) migraine, high-frequency episodic (8–14 MHDs) migraine, and chronic (≥ 15 MHDs) migraine compared with those experiencing low-frequency (1–3 MHDs) migraine in the EU5 has not been reported earlier.

The objective of this study was to characterize this additional burden of migraine with increased MHDs among migraineurs experiencing ≥4 MHDS (4–7, 8–14, and  ≥  15 MHDs) compared with those experiencing 1–3 MHDs, in terms of HRQoL, WPAI, and HRU in the EU5.

Methods The 2017 NHWS was divided into two components: a base survey component that assessed demographics, diseases experienced and diagnosed, and health outcomes (completed by all respondents) and various disease (e.g., migraine) and non-disease (e.g., vaccination) modules completed by eligible respondents.

The 2017 NHWS included the standard 4-week recall period of the revised Medical Outcomes Study 12-Item Short-Form Health Survey Instrument (SF-12v2), a multipurpose, generic health status instrument comprising 12 questions.

Higher scores indicate better HRQoL.  Several studies have used Short Form health surveys to estimate the health status of migraineurs, thus validating the instrument [11].

The EuroQol 5 dimensions (EQ-5D) index score is a preference-based measure of health, ranging on a theoretical scale from 0 to 1 (with1 being equal to full health and 0 being equal [in terms of preference] to death).

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Results A significantly higher number of visits to HCPs and neurologists (for both, p < 0.001) were observed in all of the ≥4 MHDs subgroups compared with the 1–3 MHDs subgroup.

Employed migraineurs in the 4–7 and 8–14 MHDs subgroups showed signifi- cantly greater activity impairment compared with those in the 1–3 MHDs subgroup (p < 0.0001, for both).

The total number of visits to the neurologist were significantly higher in the 4–7 (p = 0.001), 8–14, and ≥ 15 MHDs (p < 0.0001, for both) subgroups than in the 1–3 MHDs subgroup.

The numbers of total visits to the ER (p < 0.001) and psychologists (p = 0.004) were significantly higher in the ≥15 MHDs subgroup compared to the 1–3 MHDs subgroup.

Discussion A recent study by Vo and others [11] among migraineurs in the EU5 reported that migraineurs with ≥4 MHDs, particularly chronic migraineurs (> 15 MHDs), had lower HRQoL, decreased work productivity, and increased activity impairment, and greater HRU compared to non-migraine controls.

Although the previous study showed an increased burden in migraineurs with ≥4 MHDs (particularly among those with 8–14 and ≥ 15 MHDs) compared with non- migraine controls using a smaller sample size [11], the current study uses a larger sample size and reveals that there is an incremental burden due to migraine in all of the subgroups, including the 4–7 MHDs subgroup, but compared with 1–3 MHDs group.

The findings from the current study suggest that when compared with low- frequency episodic migraine (1–3 MHDs), intermediate-frequency episodic, high- frequency episodic, and chronic migraine (≥ 4 MHDs) impose a greater burden on the individual and the healthcare system.

Conclusion Although respondents experiencing 1–3 MHDs were found to be more prevalent than those experiencing ≥4 MHDs (i.e., 4–7, 8–14, and ≥ 15 MHDs), the incremen- tal burden due to migraine in terms of reduced HRQoL, greater work productivity loss and activity impairment, and increased HRU was higher among those in the ≥4 MHDs subgroups than among those in the ≤3 MHDs subgroup in the EU5.

The findings from this study suggest that respondents experiencing ≥4 MHDs, chronic migraineurs (≥ 15 MHDs) in particular, should be treated more effectively to reduce migraine frequency and lessen the burden of migraine in the EU5.

Acknowledgement A machine generated summary based on the work of Doane, Michael J.; Gupta, Shaloo; Fang, Juanzhi; Laflamme, Annik K.; Vo, Pamela. 2020 in Neurology and Therapy.

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