Total health insurance costs in children with a migraine diagnosis compared to a control group

DOI: https://doi.org/10.1186/s10194- 021- 01349- w

Abstract-Summary We aimed to assess the migraine-related health care costs in 6 to 11 year old chil- dren in Germany.

Using claims data of a large German health insurer (BARMER), overall annual health care costs of 6 to 11 year old children with a diagnosis of migraine in 2017 (n = 2597) were compared to a control group of 6 to 11 year old children without a headache diagnosis between 2013 and 2017 (n = 306,926).

Children with migraine caused considerably higher annual per capita health care costs than children without a headache diagnosis (migraine group: € 1018, control group: € 618).

Excess costs directly related to migraine amounted to € 115. The remaining excess costs were related to comorbidities, which were more fre-

quent in the migraine group.

6–11 year old children with a migraine diagnosis cause significant direct and

comorbidity related excess costs in the German health care system.

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Extended: The remaining excess costs in the migraine group are explained by the

more frequent comorbidities in the migraine group.

This resulted in the same factor for migraine (1.16) and a slightly lower adjusted

excess cost for migraine (€ 108 with 95% CI: 50;168).

Introduction Several publications analyzed health care costs for adult migraine patients, based on questionnaires [13, 172, 434] or secondary (health insurance) data [181, 435, 436].

Although migraine often starts already in primary school age [437], data on

migraine related costs in children is scarce.

A large health care data analysis from the US on children aged 2–17 years with headache found annual per capita excess costs of US$ 687 based on 779 children with headache [438].

Estimation of migraine related health care costs for children using secondary

(health care) data faces some specific challenges.

Identification of migraine related treatment costs can only be achieved by

advanced analysis of health insurance data.

Our analysis of secondary health care data with 309,523 children in total allows an elegant and (due to our large dataset) reliable estimation of both direct and comorbidity related health care costs for migraine in Germany.

Material and Methods Using ATC codes, we determined three groups of possibly headache/migraine related drugs and calculated costs of painkillers (including triptans), antiemetic drugs and headache preventive drugs.

We calculated the proportion of girls, the mean age and the mean number of dif-

ferent ICD-10 chapters with comorbidities in control and migraine group.

Frequencies and relative risks of comorbidities by ICD-10 chapters in control

and migraine group were determined.

This model allows to disentangle the estimated excess costs to directly migraine- related costs and costs associated to the higher frequency of comorbidities in the migraine group.

We modeled likewise the adjusted disease-related costs for each of the prese- lected comorbidity chapters and calculated the impact of these comorbidity chapters on cost differences between the migraine and control groups.

To assess the impact of a recent migraine diagnosis on costs, we additionally

calculated the comorbidity model for total costs for incident migraine cases only.

Results Total per capita costs were € 400 higher in the migraine compared to the con- trol group.

After adjustment for comorbidities the migraine related excess costs were

reduced to € 115.

In the migraine group, 44% of the children had a diagnosis from this chapter, thus, the average cost of comorbidities from this chapter per child was 0.44 € 807 = € 355, compared to 0.31 € 807 = € 250 in the control group.

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Economics

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€ 105 of the total excess costs in the migraine group were due to the higher pro- portion of children with a comorbidity from the “Mental and behavioural disorders” chapter.

Comorbidities from the chapters “Mental and behavioural disorders”, “Codes for special purposes” and “Diseases of the eye and adnexa” explained most of the cost difference between migraine and control group.

Discussion Main results of the present study are: A diagnosis of migraine in 6–11 year old chil- dren was associated with an average of € 400 per capita excess health care costs per year, of which € 115 (29%) were directly related to migraine.

The remaining 71% of excess costs were related to comorbidities, which were

more frequent in children with migraine.

The annual per capita excess costs in the migraine group were largely generated by primary care physician and specialist visits (€ 211  in total, corresponding to 53%, of which € 70 were directly migraine-related), with visits to the paediatrician and general practitioner accounting for the largest part.

These amounted to € 19 or 5% of the total excess costs in the migraine group.

Conclusion Direct health care costs for children were principally caused by visits to primary care physicians and specialists.

A large proportion of the costs turned out not to be directly related to migraine, but rather to the treatment of comorbidities associated with migraine, which there- fore should be a focus of future research and treatment strategies.

The fact that the largest proportion of migraine-related costs in children stemmed from visits to paediatricians and general practitioners shows that these are the most promising targets for implementation of migraine prevention strate- gies in children.

Acknowledgement A machine generated summary based on the work of Obermeier, Viola; Murawski, Monika; Heinen, Florian; Landgraf, Mirjam N.; Straube, Andreas; von Kries, Rüdiger; Ruscheweyh, Ruth. 2021 in The Journal of Headache and Pain.

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