Migraine-Related Direct Medical Costs Lower with OnabotulinumtoxinA

New Orleans—Chronic migraine (CM) patients treated with onabotulinumtoxinA reported a significant decline in emergency department (ED) visits. The results were presented at the AAN meeting during a poster session. The poster was titled Real-World Economic Impact of OnabotulinumtoxinA in Patients with Chronic Migraine.

Due to increased acute medication use, physician visits, hospitalizations, and ED visits, healthcare costs incurred by CM patients have been shown to be considerably higher than patients with episodic migraine. Results from the PREMPT (Phase III Research Evaluating Migraine Prophylaxis Therapy) study established the efficacy of onabotulinumtoxinA in improving both clinical and quality-of-life measures for CM patients. The impact of onabotulinumtoxinA therapy for CM on real-world outcomes was less clear, however.

Using the same dosing and injections paradigm employed in the PREMPT clinical trials, investigators sought to evaluate migraine-related direct medical costs before and following initiation of treatment with onabotulinumtoxinA for CM patients. Between January 2007 and April 2011, researchers evaluated CM patients presenting to a university-based specialty clinic for potential treatment with onabotulinumtoxinA. Patients were eligible for treatment if they met the International Classification of Headache Disorders-2 criteria for CM, reported failure to respond to adequate trials of at least 2 prophylactic agents, had no history of prior treatment with a neurotoxin for any indication, and were available for long-term follow-up.

At the end of the 30-day pretreatment baseline period, those patients whose headache diaries were consistent with a diagnosis of CM were treated with onabotulinumtoxinA. Following initial treatment, patients were asked to maintain a headache diary identical to that used during the baseline period. OnabotulinumtoxinA treatment was repeated at 3 months and 6 months.

The study included 230 patients with CM. The results showed that early responders (n=86) reported a positive treatment response. Delayed responders (n=24) reported benefit from treatment at the 6-month follow-up, with improvement rated a 4 or 5 on a Likert scale. The nonresponders (n=128) failed to achieve the treatment end point at any period following initiation of onabotulinumtoxinA.

Overall, the 230 patients demonstrated a mean reduction of 0.92 ED visits (log count change, −0.79; 95% confidence interval [CI], −1.0 to −0.58; P<.0001), 0.39 urgent care visits (log count change, −0.90; 95% CI, −1.3 to −0.52; P<.0001), and 0.11 hospitalizations (log count change, −0.84; 95% CI, −1.4 to −0.31; P=.002). Application of conservative national estimates to the mean reduction in healthcare resource use (HRU) yielded a reduction of $1025 per patient (total cost reduction: $228,575). This reduction in HRU offset approximately 40% of the treatment cost for 6 months of treatment.

All 3 groups showed statistically significant reduction in ED (P<.002 for all) and urgent care use (P<.015 for all). Early responders demonstrated an 86% reduction in ED visits, while delayed and nonresponders showed large drops in ED visits (60% and 29%, respectively). Only the early responder group, however, demonstrated a statistically significant change in migraine-related hospitalizations (P=.015).

Limitations of the study included the lack of a control arm, reliance on patient recall for HRU for the first 6 months prior to initiation of therapy, and the cost analysis did not factor in the reduction in use of abortive medication or other prophylactic therapy, elective visits to healthcare providers, or electively performed diagnostic studies.

Given the safety and efficacy of onabotulinumtoxinA, the significant reduction in migraine-related direct medical costs, and indirect costs presumed to occur in responders, the researchers concluded “a strong case can be made for positioning onabotulinumtoxinA as the currently preferred treatment for CM.”

This study was funded by Allergan, Inc.