Burden of Migraine in the United States

Hu, Xiaohan; Markson, Leona E.; Lipton, Richard B.; Stewart, Walter F.; Berger, Marc L.

doi:10.1001/archinte.159.8.813

Cited by 826 publications

(685 citation statements)

References 23 publications

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“…[4][5][6][7] The National Headache Foundation defined migraine as episodic (<15) or chronic (≥15 days per month for at least 3 months). [8][9][10] Many adults with episodic migraine experience serious lifestyle restrictions [11][12][13] and need preventive medications. 5,14,15 The US Food and Drug Administration (FDA) has approved four drugs for episodic migraine prevention in adults: two beta blockers (propranolol and timolol) and two antiepileptic drugs (topiramate and divalproex sodium).…”

Section: Introductionmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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ELIGIBILITY CRITERIA: English-language randomized controlled trials (RCTs) of preventive drugs compared to placebo or active treatments examining rates of ≥50 % reduction in monthly migraine frequency or improvement in quality of life. STUDY APPRAISAL AND SYNTHESIS METHODS:We assessed risk of bias and strength of evidence and conducted random effects meta-analyses of absolute risk differences and Bayesian network meta-analysis. RESULTS: Of 5,244 retrieved references, 215 publications of RCTs provided mostly low-strength evidence because of the risk of bias and imprecision. RCTs examined 59 drugs from 14 drug classes. All approved drugs, including topiramate (9 RCTs), divalproex (3 RCTs), timolol (3 RCTs), and propranolol (4 RCTs); offlabel beta blockers metoprolol (4 RCTs), atenolol (1 RCT), nadolol (1 RCT), and acebutolol (1 RCT); angiotensin-converting enzyme inhibitors captopril (1 RCT) and lisinopril (1 RCT); and angiotensin II receptor blocker candesartan (1 RCT), outperformed placebo in reducing monthly migraine frequency by ≥50 % in 200-400 patients per 1,000 treated. Adverse effects leading to treatment discontinuation (68 RCTs) were greater with topiramate, off-label antiepileptics, and antidepressants than with placebo. Limited direct evidence as well as frequentist and exploratory network Bayesian meta-analysis showed no statistically significant differences in benefits between approved drugs. Off-label angiotensin-inhibiting drugs and beta-blockers were most effective and tolerable for episodic migraine prevention. LIMITATIONS:We did not quantify reporting bias or contact principal investigators regarding unpublished trials. CONCLUSIONS: Approved drugs prevented episodic migraine frequency by ≥50 % with no statistically significant difference between them. Exploratory network meta-analysis suggested that off-label angiotensin-inhibiting drugs and beta-blockers had favorable benefit-to-harm ratios. Evidence is lacking for longterm effects of drug treatments (i.e., trials of more than 3 months duration), especially for quality of life.KEY WORDS: migraine; evidence based medicine; adverse drug effects.

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Section: Introductionmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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“…The cost of aggressive medical management (emergency department visit, IV medication) was estimated based on published literature examining the direct medical costs of migraineurs. 12 The cost of surgery to repair a spinal dural leak was estimated based on published literature examining inpatient care costs of migraineurs and Medicare reimbursement rates for imaging to identify the location of the leak (CT myelography) and surgical repair of the leak (CPT codes 62284, 72265, 72132, 63707, 63709). 12 The analysis was conducted from the health care perspective; thus indirect and societal economic costs such as loss of work productivity were not included.…”

Section: Methods Model Overviewmentioning

confidence: 99%

Cost comparison between the atraumatic and cutting lumbar puncture needles

Tung¹,

So²,

Lansberg³

2012

Neurology

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Objective: The aim of this study was to determine which type of spinal needle is preferred from a cost perspective, taking into account costs of the spinal needle and treatment of postlumbar puncture headache. Methods:A decision-analytic model was created to determine the cost of diagnostic lumbar punctures using atraumatic and cutting needles. We assumed a health care system perspective and based the analysis on the treatment of a patient facing event probabilities derived from prior studies. The economic outcome measure was the difference in estimated costs between the 2 needles. One-way and probabilistic sensitivity analyses tested the robustness of the model. Results:Lumbar puncture performed with the atraumatic needle is associated with an average cost savings of $26.07 per patient. Average total health care costs are $166.08 with the atraumatic needle, compared to $192.15 with the cutting needle. There is 94% certainty that the atraumatic needle is cost-saving compared to the cutting needle based on probabilistic sensitivity analysis. Use of the atraumatic needle over the cutting needle by neurologists alone may result in $10.4 million in cost savings to the US health care system per year. Conclusion:The atraumatic spinal needle is associated with an overall cost savings to the US health care system. The balance of costs and benefits favors the use of the atraumatic needle over the cutting needle for diagnostic lumbar puncture. Neurology ® 2012;78:109-113Every year approximately 400,000 diagnostic lumbar punctures are performed by neurologists in the United States. 1 Recent studies have shown that the "atraumatic," pencil-point Sprotte spinal needle is associated with a lower incidence of postlumbar puncture headache compared to the conventional "cutting" Quincke needle. 2,3 Although the use of the atraumatic needle is standard practice among anesthesiologists for spinal anesthesia, only 2% of neurologists routinely use atraumatic needles. The most common reasons given by neurologists for not using the atraumatic needle are nonavailability and expense. 4 There have been no formal decisionanalytic studies evaluating the costs associated with the use of each of these spinal needles. 5 The goal of this study was to determine whether the atraumatic or the cutting spinal needle is preferred from a cost perspective, taking into account the initial procedural costs and the costs associated with treatment of postlumbar puncture headache. METHODS Model overview.A decision-analytic model was created (TreeAge Software, Inc.) to determine the costs of diagnostic lumbar punctures with the atraumatic and cutting spinal needles ( figure 1). In the analysis, we estimated average health care costs of each alternative from the time of the lumbar puncture to the resolution of postlumbar puncture headache. Not experiencing a postlumbar puncture headache and resolution of postlumbar puncture headache are the absorbing states after which the patient is excluded from the model. No further costs incurred by the absorbing ...

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“…The economic consequences of the disease are considerable, placing a significant burden on patients, health plans and employers worldwide [2][3][4][5][6]. Individuals that receive treatment for migraine generally consume more health care resources than patients without the condition [7].…”

Section: Introductionmentioning

confidence: 99%

Effect of daily migraine prevention on health care utilisation in an insured patient population

Devine¹,

Hadsall

Cline

et al. 2007

J Headache Pain

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The economic benefits of daily migraine prevention have been subject to ongoing debate. This study was undertaken to determine if the initiation of prevention had an observable effect on ambulatory health care utilisation when compared to acute migraine treatment alone. Administrative claims data from the Military Health System were used to conduct a retrospective, longitudinal cohort study of 3762 patients with migraine. New users of daily migraine prevention were matched to a reference group of non-users using propensity score methods. This matched sample then was used to evaluate the effect of prevention on ambulatory health care expenditures. The study results showed that exposure to daily migraine prevention led to lower rates of utilisation relative to what new patients would have consumed in the absence of treatment. The results suggest that additional economic benefits could be realised by increasing the appropriate use of daily migraine prevention.

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Burden of Migraine in the United States

Abstract: Background: Migraine is a common disabling disease but its economic burden has not been adequately quantified.

Cited by 826 publications

References 23 publications

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Cost comparison between the atraumatic and cutting lumbar puncture needles

Effect of daily migraine prevention on health care utilisation in an insured patient population

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