All-cause Healthcare Resource Utilization and Costs Among Patients With Episodic or Chronic Migraine and Comorbid Depression and/or Anxiety

Objective: This real-world retrospective cohort study evaluated healthcare resource utilization (HCRU) and costs for adult patients with episodic migraine (EM) or chronic migraine (CM) and medically-diagnosed depression and/or anxiety who were commercially or Medicare Advantage insured.

Methods: Patients with EM or CM were identified from a large US employer administrative claims database from 2015-2018. Three cohorts of patients (medically-diagnosed anxiety only; depression only; both depression and anxiety) were compared to EM or CM patients without depression/anxiety for all-cause HCRU and associated costs over 1 year.

Results: Of EM patients (N=156,451) and CM patients (N=19,979), respectively, 7.2% and 7.4% had comorbid anxiety, 5.9% and 8.3% had comorbid depression, 6.7% and 8.8% had both depression and anxiety, and 80.2% and 75.6% had neither. For EM and CM patients, mean numbers of inpatient, emergency department (ED), and outpatient healthcare professional visits, as well as mean total costs, were significantly higher for patients with depression/anxiety versus those without depression/anxiety (all P < 0.01). Patients with both anxiety and depression had greater HCRU and costs than those with either anxiety or depression alone.

Conclusion: EM or CM patients with medically-diagnosed depression and/or anxiety have significantly greater all-cause HCRU and costs than those without comorbid depression and/or anxiety in Commercial and Medicare Advantage populations. As costs increase with presence of anxiety and/or depression in migraine patients, migraine preventive therapies that show improved real-world effectiveness among patients with additional burdens, such as comorbid anxiety and/or depression, may be more cost-effective than therapies that improve migraine alone.