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Migraine and loss of work

Clinical bottom line

Migraine is associated with a substantial amount of time lost from work. In screening 2670 patients for phase III clinical trials, the average estimates for lost work were 8.3 days lost due to absenteeism, and 11.2 days lost because of reduced efficiency. The estimated cost to employers was US$3,309 (year 2000 prices).


Study

A questionnaire (Migraine background Questionnaire) was developed to estimate the economic burden of illness associated with migraine. It was tested for clarity in migraine patients in 25 countries, and captured the following information:

The questionnaire was self-administered in patients at screening visits at 23 US and 73 non-US sites for phase III clinical trials of rizatriptan. These were people aged 18 to 65 years with 1-8 moderate to severe migraines per month in the past six months.

Results

There were 2670 completed questionnaires from 2674 patients, 55% in Europe, 17% in Latin America, and 23% in North America. Thirty-nine patients reported no migraine in the previous four weeks, giving 2631 evaluable questionnaires. The mean age of patients was 39 years, 82% were women, with 3.7 episodes of migraine in the previous four weeks. Full or part-time employment was reported by 68%, self-employment by 7%, 15% were students or home-makers and others were looking for work, were retired, or were unable to work for health reasons. The type of employment was managerial or professional in 23%, in a service industry in 14%, secretarial or clerical in 16% and other in 47%.

Use of medical services

Healthcare use was recorded as annual use. The overall average was 2.8 doctor or clinic visits, 0.5 emergency room visits and 0.06 hospitalizations. This means that for every 10,000 patients with migraine there would be 28,000 visits to the doctor, 5000 visits to the emergency room, and 6 patients admitted to hospital. These rates were similar across all geographical regions, though emergency room visits were lower in Europe and higher in the Americas.

Work and productivity loss

On average, every four weeks each migraine sufferer were absent from paid work on 0.64, and worked with migraine for 3.6 days. There were 12.7 hours worked with migraine, during which they were only about half (46%) as effective as usual, so that every four weeks an average of 6.9 hours of work were lost due to ineffectiveness. These rates were similar across all geographic regions.

The annual loss of paid work was equivalent to 19.5 days per migraine sufferer. This was similar across geographic areas. In the USA, the economic impact of lost work hours would be equivalent to US$3,309 per migraine sufferer per year.

The amount of unpaid work and productivity loss was greater than that for paid work. On average there were 1.4 lost workdays, and they worked with migraine for 3 days a month. There were 10.6 lost work hours per month through lower effectiveness while at work.

Comment

The paper gives detailed information for each of the counties, from the 14 respondents in Iceland to the 469 in the USA and 402 in the UK. There are some interesting country-by-country variations, but much of that is likely to be due to the small numbers in some countries. Work hours lost through monthly lost workdays were highest in Norway (2.3) and Canada (2.1) and lowest in Mexico and Colombia (0.7). Work hours lost through monthly work hours lost through ineffectiveness while at work with a migraine were highest in Belgium (36) and Canada (15) and lowest in South Africa (5) and Israel (7).

Is the work credible? Well, another estimate of migraine-associated productivity loss in the USA put the figure at about US$14 billion. This paper estimates US$3,300 per worker. So for this to be credible there would need to be 4 million US workers aged 16-65 years with 1-8 migraines a month. With a US population of about 260 million, of whom, say, half were economically active, to suggest that 3% fell in the clinical category of migraine described here is reasonable.

What is important about this study is not only that it confirms other studies about the economic (and personal) impact of migraine, but also gives solid information on which to calculate country-specific impacts.

Reference:

WG Gert et al. The multinational impact of migraine symptoms on healthcare ultization and work loss. Pharmacoeconomics 2001 19: 197-206.