Migraine treatment and healthcare costs: retrospective analysis of the China Health Insurance Research Association (CHIRA) database

DOI: https://doi.org/10.1186/s10194- 020- 01117- 2

Abstract-Summary Information on prescribing patterns and treatment costs of migraine in China is limited.

This retrospective analysis of the China Health Insurance Research Association (CHIRA) medical insurance claims database in 2016 to 2017 evaluated treatment patterns, direct medical costs, and healthcare resource utilization among adults with migraine in mainland China.

Of 108,375 patients with headache-related outpatient visits, 10,652 were adults

with migraine (mean age 51.4 years, 55.4% female).

Migraine patients were prescribed acute medication (26.4%), preventive medica- tion (15.0%), and Chinese patent and herbal medicines (24.5% and 11.7%, respectively).

Medication costs for traditional Chinese medicine (22.4 USD per patient) were

higher than for Western medicine (13.5 USD).

Among migraine patients in China, NSAIDs were commonly prescribed as acute medication, while utilization of migraine-specific triptans and preventive medica- tions was low.

Extended: This retrospective analysis of the China Health Insurance Research Association (CHIRA) nationwide medical insurance claims data aimed to under- stand the treatment patterns, direct medical costs, and healthcare resource utiliza- tion among adult patients with migraine in mainland China.

The findings indicate an economic burden associated with the diagnosis and treatment of migraine in China, and possible unmet needs for effective migraine- specific acute treatment as well as preventive medication.

Background Migraine treatment guidelines for China are consistent with those for Europe and the United States (US) in supporting a stratified approach to acute (abortive) treat- ment, whereby medication choice is based on attack severity and symptoms, the

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efficacy and side effect profile of the drug, and the patient’s previous response to acute treatment [50, 90, 118, 131, 142, 183–432].

Although there is substantial evidence for the economic burden of migraine in the US and Europe, this information cannot be generalized to China because of the differences in diagnosis and treatment practices, availability of prescription medica- tion, and use of traditional Chinese medicine alongside Western medicine.

A population-based survey in China in 2009 estimated the total annual direct costs of migraine diagnosis and treatment to be 58.0 billion Chinese yuan renminbi (CNY) (8.4 billion US dollars [USD]) [4].

Methods The CHIRA database is a medical insurance management information system initi- ated in 2007 that contains nationwide consecutive inpatient and outpatient visit claims data of urban basic medical insurance in China.

All outpatient visit and healthcare use information for the diagnosis and treat-

ment of headache in 2016 and 2017 was extracted from the CHIRA database.

Adult patients (≥18  years) were selected who had a primary diagnosis of migraine, identified by International Statistical Classification of Diseases and Related Health Problems revision 10 (ICD-10) code (ICD-10 G43.0, G43.1, G43.2, G43.3, G43.8, G43.9) and supplemented by searching physician Chinese character descriptions against translations from the World Health Organization Chinese ver- sion of ICD-10.

Patient information identified from the CHIRA database included age, gender, comorbidities (predefined as anxiety, major depressive disorder, epilepsy, fremitus, and insomnia), and medical insurance type (Urban Employee Basic Medical Insurance or Urban Residents Basic Medical Insurance).

Medication costs were calculated for prescribed Western medicine and for

Chinese patent or herbal medicine.

Results The majority (68.8%) of patients receiving acute medication were prescribed non- aspirin NSAIDs, with ibuprofen being the most common (36.5%).

Other classes of acute medication were each prescribed to ≤8.0% of patients

receiving acute medication, including opioids (7.1%) and ergot alkaloids (6.1%). Only 3.3% of patients receiving acute medication were prescribed a triptan. Other classes were each prescribed to less than 4% of the patients receiving pre-

ventive medication.

The proportions of patients prescribed Chinese patent or herbal medicine were comparable with those prescribed Western acute (26.4%) or preventive (15.0%) medications.

Discussion This is the first study to describe the treatment patterns and costs of migraine treat- ment in urban mainland China using a retrospective analysis of the large CHIRA medical insurance claims database.

Only 26.4% of patients were prescribed acute medication, which contrasts with higher rates (73%) from Japanese insurance claims data [433]; this may reflect

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cultural differences in prescribing patterns or greater reliance on over-the-counter rather than prescription acute medications in China.

Although the Level A evidence supporting triptan use is recognized in Chinese as well as international treatment guidelines [50, 90, 118, 131, 142, 183–432], the rate of triptan prescribing in this study was low; of patients receiving acute medica- tion, only 3.3% were prescribed triptans.

Although we cannot determine whether the 7.1% of patients who were pre- scribed opioids in our study were non-responders to other medications, this rate of opioid prescription demonstrates an unmet need for additional migraine-specific acute treatments that lack the safety concerns of opioids.

Conclusions Prescribing rates for acute medication in China were low compared with the US and Japan.

NSAIDs were the most commonly prescribed acute medication, while there was

low utilization of migraine-specific triptans and preventive medications.

The findings indicate an economic burden associated with the diagnosis and treatment of migraine in China, and possible unmet needs for effective migraine- specific acute treatment as well as preventive medication.

Acknowledgement A machine generated summary based on the work of Yu, Shengyuan; Zhang, Yanlei; Yao, Yuan; Cao, Haijun. 2020 in The Journal of Headache and Pain.

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