Structured headache services as the solution to the ill-health burden of headache. 2. Modelling effectiveness and cost- effectiveness of implementation in Europe: methodology

DOI: https://doi.org/10.1186/s10194- 021- 01310- x

Abstract-Summary Health economic evaluations support health-care decision-making by providing information on the costs and consequences of health interventions.

No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of interventions designed to close treatment gaps for headache disorders in countries of Europe (or elsewhere).

Our aim here, within the European Brain Council’s Value-of-Treatment project, was to develop headache-type-specific analytical models to be applied to imple- mentation of structured headache services in Europe as the health-care solution to headache.

We developed three headache-type-specific decision-analytical models using the WHO-CHOICE framework and adapted these for three European Region country settings (Luxembourg, Russia and Spain), diverse in geographical location, popula- tion size, income level and health-care systems and for which we had population- based data.

Each model compared current (suboptimal) care vs target care (delivered in

accordance with the structured headache services model).

Headache-related costs (including use of health-care resources and lost produc-

tivity) and health outcomes (HLYs) were mapped across populations.

This study presents the first headache-type-specific analytical models to evaluate effectiveness and cost-effectiveness of implementing structured headache services in countries in the European Region.

Extended: No universally accepted methodology exists for modelling effective- ness and cost-effectiveness of service-delivery interventions designed to close head- ache treatment gaps.

Our aim here, through decision-analytical modelling, is to generate the required

evidence of value needed to influence policy.

We developed three separate headache-type-specific decision-analytical models from an earlier exercise using the WHO-CHOICE framework [492], and simulated outcomes for the populations of 18–65-year-olds with migraine, TTH or MOH.

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1 Public Health

This study presents the first headache-type-specific analytical models for com- paring the effectiveness and cost-effectiveness of implemented structured headache services across European Region country settings.

Background Each million of the population in Europe loses an estimated 400,000  days from work or school every year to migraine alone, while the estimated cost of headache disorders in Europe, due in the main to lost productivity, is well in excess of €100 billion per year [13].

No universally accepted methodology exists for modelling effectiveness and cost-effectiveness of service-delivery interventions designed to close headache treatment gaps.

We describe current care and the treatment management plan to achieve target care, the types of intervention, and the coverage and uptake estimates used in three headache-type-specific decision-analytical models.

We explain how we calculate economic and health outcomes, and report the key results of applying the three analytical models to population data from three para- digmatic countries in the European Region, including healthy life years (HLYs) gained and cost differences when changing from current to target care.

Methods We ran a population model for the two alternatives (current vs target care) over one- and five-year time frames to estimate total HLYs lived by the populations in each country in each alternative.

The differences between these two simulations represented the population-level

health gain (HLYs gained) from the intervention relative to current care.

For migraine and TTH, we calculated headache-attributed disability at individual level in YLDs as the product of proportion of time in ictal state (pTIS: itself esti- mated as a product of attack frequency (F) and mean duration), with and without intervention, and the DW for the disorder in question.

We modelled treatment effect as reduction in pTIS, adopting the universal out- come measure previously developed for this purpose [493] but, since this was a population-level analysis, expressing effect in terms of HLYs gained rather than hours lived with disability (HLDs) averted.

Results We set out results for the three countries in terms of headache-related costs (includ- ing use of health-care resources and lost productivity) and health outcomes (HLYs) attached to each alternative (current vs target care) only to demonstrate how the models worked.

Analyses of the differences in costs and health outcomes between alternatives

and the incremental cost-effectiveness ratios are presented elsewhere [494].

The same calculations are repeated for each alternative (current vs target care)

and for the differences between these.

The same calculations are again repeated for each alternative (current vs target

care) and for the differences between these.

1.4

Governance

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Discussion The models linked direct costs (resources sunk into health-care provision) and indi- rect costs (lost work productivity) with health outcomes (in terms of HLYs).

The countries included—Luxembourg, Russia and Spain—were diverse in terms of geographical location, population size, level of income and organisation of their health-care systems.

This allowed us to re-run the models from the broader societal perspective, cov-

ering both health-care provider costs and those due to lost productivity.

A major difficulty lay in the relationship between headache-attributed disability, estimated from DWs generated in GBD2015, and headache-attributed lost work productivity.

This was expected, because predicted savings in work productivity greatly exceeded the investments in health care estimated to be needed to achieve these savings.

In a conservative scenario, where we assumed that remedying disability would recover only 20% of the lost productivity attributed to it, the intervention remained cost-effective in all models and cost-saving in Luxembourg.

Conclusion Despite these limitations, the study delivered robust models, with detailed results presented in the next paper in this series [494].

The models should greatly assist local health-policy makers, across Europe and very probably elsewhere, in allocating fixed health budgets between interventions to maximise health in society.

Health-care systems vary widely even within the European Region, and certainly outside it, but the analytical models should be applicable to any that adopt and fully implement the services model [495].

Acknowledgement A machine generated summary based on the work of Tinelli, Michela; Leonardi, Matilde; Paemeleire, Koen; Mitsikostas, Dimos; de la Torre, Elena Ruiz; Steiner, Timothy J.; 2021 in The Journal of Headache and Pain.

Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost- effectiveness of implementation in Europe: findings and conclusions