Migraine Treatment Failure Associated With High HCRU

Managing migraine is associated with substantial economic burden prompting researchers to examine the association between overall health care resource utilization (HCRU) and treatment failure. 

Lawrence Newman, MD, NYU Langone Health, headache division, New York, NY, and colleagues sought “to characterize HCRU and associated costs among migraine patients, categorized by number of preventive treatment failures (TF; 1TF, 2TF, ≥3TF).”

Using data from the IBM MarketScan Commercial and Medicare Supplemental database, the researchers identified newly diagnosed migraine patients between January 1st, 2011 and June 30th, 2015. Treatment failures (TF) were identified two years following initial migraine diagnosis, and HCRU and associated costs assessed in 12 months post-index date. Index dates for 1TF patients was the date of their 2nd preventive treatment (PT) initiation, 2TF their 3rd and ≥3TF patients their 4th PT initiation, clarified the researchers. 

Of the 44,181 incident migraine patients included in the study’s final cohort, who had failed preventive treatments, 61.4% (27,112) had 1TF, 24% (10,583) had 2TF and 14.7% (6,486) had ≥3TF, respectively. 

The total medical (emergency room + inpatient + outpatient) per-patient cost increased with increase in number of TF (1TF: $10,329; 2TF: $13,774; ≥3+TF: $35,392). On adding prescription drug costs, the total health-care costs also increased with number of TF (1TF: $13,946; 2TF: $18,685; ≥3TF: $41,864). 

Similarly, the per-patient annual health-care provider visits increased with increase in number of TF. The number of emergency room visits per year ear were 0.54, 0.69, and 1.02 for 1TF, 2TF, and ≥3TF patients respectively, while those for inpatient were 0.46, 0.59, and 0.97. 

A similar trend was seen with outpatient visits (office visits: 1TF: 9.47, 2TF: 11.24, ≥3TF: 14.26, other visits: 1TF: 13.15, 2TF: 15.73, ≥3TF: 19.96).

“The HCRU and associated costs were highest for ≥3TF patients, followed by 2TF and 1TF patients, suggesting that increase in TF is associated with increase in economic burden,” concluded the researchers.  —Edan Stanley