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Health economics of migraine

Health economics are difficult at any time, varying as they do in geography, time, and circumstance. Do we take only the costs of prescription, or the costs to an individual, or those costs within a healthcare system, or the costs of society as a whole? All of these considerations apply with some force to migraine, and so Bandolier is not going to attempt a complete review. In other parts of this section come abstracts of studies we think are important, either because of their results or their methods.

We have, though, sifted through the literature and found a whole series of papers of greater or lesser interest. The table below give the reference and a brief outline of what each paper contains. The studies are often reports of workdays or productivity lost during migraine attacks, and improved with various treatments, or are broader descriptions of studies in migraine that look at economic or quality of life indicators. This table is by no means exhaustive, but rather is an indication of the types and extent of information available. Bandolier was unable to find a single review that brought it all together and made sense for those of us with little brain. The colours change according to year of publication, and the table starts with the oldest.



Jones & Harrop. Study of migraine and the treatment of acute attacks in industry. J Int Med Res 1980 8:321-325. Reports on treatment of migraine at general Foods in Banbury, Oxfordshire in 8 months in 1979. There were 111 attacks covering 6% of the 2000 workforce. Workdays lost would amount to 420 per year.
Rasmussen et al. Impact of headache on sickness absence and utilisation of medical services: a Danish population study. J Epidemiol Comm Health 1992 46: 443-446. Random sample of population. 119 with migraine, 578 with tension headache. Migraineurs were four times more likely to consult GP or specialist, and lost more workdays. Migraine workdays lost per year due to migraine was estimated at 270 days per 1000 persons, compared with 820 for tension headache.
Clouse & Osterhaus. Healthcare resource use and costs associated with migraine in a managed healthcare setting. Ann Pharmacother 1994 28: 659-664. Retrospective analysis of managed care system using 1336 migraineurs and a comparison group of 1336 with at least one medical claim not migraine. Migraineurs generated twice as many claims, and 2.5 times as many pharmacy claims. Medical and pharmacy costs were $3.4 million and $2.1 million respectively.
Kaa et al. Emergency department resource use by patients with migraine and asthma in a HMO. Ann Pharmacother 1995 29: 251-256. 2% of 16755 walk-in emergency department visits were for migraine and 1% for asthma.
Clarke et al. Economic and social impact of migraine. Q J Med 1996 89:77-84. Survey of 4200 employees of trust hospital, with 50% response identifying 158 migraine sufferers. Estimated 2 days lost through absence and 5.5 days through reduced effectiveness a year. An additional 220 patients who fulfilled only 3 of 4 HIS criteria lost 7 days a year. Total cost to the trust was £113,000 a year, though few patients had seen a GP.
Gross et al. Impact of oral sumatriptan 50 mg on work productivity and quality of life in migraineurs. BJME 1996 10: 231-246. Productivity data collected during an open, non-randomised study. Reports an average gain of 6.8 work days a year over usual therapy.
Litaker et al. Impact of sumatriptan on clinic utilization and costs of care in migraineurs. Headache 1996 36: 538-541. 104 patients attending a hospital clinic reported information for 18 months before and after sumatriptan use began. Median number of visits and costs fell.
Miller et al. Sumatriptan and lost productivity time: a time series analysis of diary data. Clin Ther 1996 18: 1263-1275. Modelling of data from two clinical trials. Results suggested use of sumatriptan produced savings of 0.8 hours of nonworkplace and 0.5 hours of workplace time per week.
Cortelli et al. A multinational investigation of the impact of subcutaneous sumatriptan: workplace activity and non-workplace activity. Pharmacoeconomics 1997: 11 Suppl1: 35-42. Study in 582 patients measuring time lost during customary therapy and with subcutaneous sumatriptan.
Coukell & Lamb. Sumatriptan: a pharmacoeconomic review of its use in migraine. Pharmacoeconomics 1997 11: 473-490. A summary of pharmacoeconomic studies with sumatriptan.
Lipton & Stewart. Prevalence and impact of migraine. Neurology Clinics 1997 15: 1-13. A thoughtful and well referenced survey on the epidemiology and economics of migraine.
Lipton et al. Burden of migraine: societal costs and therapeutic opportunities. Neurology 1997 48 Suppl 3: S4-S9 Reprises some of the above, plus some interesting health economics reviewed.
Legg et al. Cost benefit of sumatriptan to an employer. J Occ Envir Med 1997 39:652-657. A work productivity outcomes assessment showing that days off work and productivity lost were reduced by sumatriptan in a 164-person open telephone survey. Benefit was $435 versus cost of $44 each month.
Larbig & Brüggenjürgen. Work productivity and resource consumption among migraineurs under current treatment and during treatment with sumatriptan - an economic evaluation of acute treatment in moderate to severe migraineurs. Headache Q 1997 8:237-246. 198 patients in open trial using one-month pre introduction with 4 months post introduction of subcutaneous sumatriptan. Reports reduced costs and hours lost from work with sumatriptan.
Schwartz et al. Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occ Envir Med 1997 39:320-327. Over 13,000 respondents gave self-reports of work missed through headache. 57% of 10,000 lost workdays due to migraine.
Dartriguez et al. Comparative view of the socioeconomic impact of migraine and back pain. Cephalalgia 1998 18 Suppl 21: 26-29. Use of a cohort of 20,000 people working for French utility companies with mailed annual health questionnaires. Between 1989 and 1992 there were 436 people with migraine, 590 with back pain, 555 with both and 1005 with neither chosen. Migraine scored low in SF36 quality of life indicators, but had no fewer lost days. The combination with low back pain was much worse.
Ducharme et al. Emergency management of migraine: is the headache really over? Acad Emerg Med 1998 5: 899-905. Prospective 72-hour follow-up of 143 patients visiting emergency department for headache.
Durham et al. Quality of life and productivity in nurses reporting migraine. Headache 1998 38: 427-435. 10,000 nurses sampled with 2949 returning questionnaires. 17% had migraine according to HIS criteria. Migraineurs had lower quality of life and productivity.
Ferrari. The economic burden of migraine to society. Pharmacoeconomics 1998 13:667-676. Review article.
Laloux et al. Subcutaneous sumatriptan compared with usual acute treatments for migraine: clinical and pharmacoeconomic evaluation. Acta neurol belg 1998 98: 332-341. Study in 186 outpatients randomised to SC sumatriptan or usual treatment. Claims lower number of work and non-work hours lost and lower costs with subcutaneous sumatriptan. Lots of references, so useful.
Lipton et al Medical consultations for migraine: results from the American Migraine Study. Headache 1998 38:87-96. Results of a mailed questionnaire to 15,000 US households. Shows that a significant number of migraine sufferers never consult a doctor
Monzón & Lláinen. Quality of life in migraine and chronic daily headache patients. Cephalalgia 1998 18: 638-643. SF36 used in 115 consecutive patients at headache clinic.
Cohen et al. Sumatriptan for migraine in a health maintenance organisation: economic, humanistic and clinical outcomes. Clin Ther 1999 21: 190-204. Medical record review of 148 patients on open label sumatriptan for a year before and after treatment began. Reports reduced healthcare use and improved quality of life, productivity, and satisfaction with treatment.
Lofland et al. Changes in resource use and outcomes for patients with migraine treated with sumatriptan. Arch Intern med 1999 159:857-863. Prospective observational study on 178 persons receiving first prescription for sumatriptan. Shows lower healthcare use and better quality of life.

If there are important studies that we have missed we'd love to hear about them.