Migraine-Related Disability Directly Impacts Health Care Utilization in Episodic Migraine

The investigators concluded that the MIDAS questionnaire may be a useful tool in the development, testing, and prescription of cost-effective medications for those with migraine whose direct and indirect costs are high.

Richard B. Lipton, MD

Patients with episodic migraine who have higher migraine-related disability, as demonstrated by scores on the Migraine Disability Assessment Scale (MIDAS) questionnaire, were associated with increased healthcare resource utilization (HCRU), newly published real-world data show.1

At the conclusion of the retrospective, 6-month cohort study, investigators reported a difference of hundreds of dollars between those who had little to no migraine-related disability and those with disability that was considered very severe. Senior author Richard B. Lipton, MD, and colleagues also wrote that "MIDAS captures days of missed work or school due to headache (absenteeism), and days during which headaches led to reduced productivity (presenteeism) and thus may be used to estimate indirect costs. Therefore, it could be used as a tool to facilitate the targeting of specific pharmacological treatments to people with high direct and indirect migraine-related costs, thereby alleviating the substantial economic burden associated with the disorder in the United States."

In the analysis, Lipton, who is director of the Montefiore Headache Center, and colleagues assessed 7662 patients with episodic migraine using claims and electronic health record data from the Decisions Resources Group database. In total, 43.7% (n = 3348) had MIDAS disability grade of I (little or none), 14.4% (n = 1107) had a MIDAS grade of II (mild), 16.0% (n = 1225) had a MIDAS grade of III (moderate), 11.7% (n = 893) had a MIDAS grade of IVa (severe) and 14.2% (n = 1089) had a MIDAS grade of IVb (very severe).

Questionnaires were completed from January 2016 to December 2018. In multivariable analysis that was based on adjusted cost estimates, worsening migraine disability was associated with both increased healthcare costs due to medical visits and pharmacy use. Additionally, the study also highlighted that 74.1% of participants had MIDAS grades of III or lower, indicating that most participants experienced mild to moderate migraine-related disability.

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Among those treated in specialty practice, patients with MIDAS grades IVa and IVb had the highest total costs associated with their care. At 6-months post index (n = 1524), costs attributable to healthcare visits ranged from $509 (95% CI, 411-629) for participants with little to no disability to $885 (95% CI, 634-1236) for those with the most severe migraine-related disability. In the analysis of the total pharmacy costs at 6 months post index (n = 1112), costs ranged from $492 (95% CI, 378-645) for those with MIDAS grade I to $1020 (95% CI, 643-1620) for those with the highest MIDAS grades.

Participants treated in primary care documented similar, yet slightly lower mean HCRU costs as those in specialty practice. At 6 months post index (n = 974), healthcare costs attributable to healthcare visits ranged from $206 (95% CI, 144-294) to $631 (95% CI, 384-1036) for those with the lowest and highest MIDAS scores, respectively. As for pharmacy costs during that time (n = 764), they ranged from $203 (95% CI, 136-301) for participants with MIDAS grade I to $719 (95% CI, 410-1259) for those with MIDAS grade IVb.

"Although mean costs due to healthcare visits and pharmacy use were higher among participants treated in specialty practice, further analysis is required to determine if this cost difference is of statistical significance," Lipton et al noted.

1. Harris L, L’Italien G, BEng A, et al. Real-world assessment of the relationship between migraine-related disability and healthcare costs in the United States. Headache. Published March 28, 2022. doi:10.1111/head.14289
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