Economic consequences of migraine in Sweden and implications for the cost-effectiveness of onabotulinumtoxinA (Botox) for chronic migraine in Sweden and Norway

Abstract

Background Migraine is a common and incapacitating condition, with severe impact on the quality of life (QoL) of the afflicted and their families, and negative economic consequences through decreased workforce participation, reduced functional ability and elevated healthcare costs. This study aimed to describe the economic consequences of migraine in Sweden using cost of illness survey data and, based on this data, assess the cost-effectiveness of onabotulinumtoxinA (Botox) for the treatment of chronic migraine in Sweden and Norway. Methods A survey study was conducted in Swedish migraine patients, with questions on patient characteristics, headache frequency and severity, effect on daily activities and work, QoL, health resource utilization, and medication use. Resulting costs were estimated as annual averages over subgroups of average monthly headache days. Some results were used to inform a Markov cost-effectiveness chronic migraine model. The model was adapted to Sweden and Norway using local data. The analysis perspective was semi-societal. Results’ robustness was tested using one-way, structural, and probabilistic sensitivity analyses. Results Results from the cost of illness analysis ( n = 454) indicated a clear correlation between decreased QoL and increased costs with increasing monthly headache days. Total annual costs ranged from EUR 6221 in patients with 0–4 headache days per month, to EUR 57,832 in patients with 25–31. Indirect costs made up the majority of costs, ranging from 82% of total costs in the 0–4 headache days group, to 91% in 25–31 headache days. The cost-effectiveness analyses indicated that in Sweden, Botox was associated with 0.223 additional QALYs at an additional cost of EUR 4126 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of EUR 18,506. In Norway, Botox was associated with 0.216 additional QALYs at an additional cost of EUR 4301 compared to placebo, resulting in an ICER of EUR 19,954. Conclusions In people with migraine, an increase in monthly headache days is clearly related to lower QoL and higher costs, indicating considerable potential costs-savings in reducing the number of headache days. The main cost driver for migraine is indirect costs. Botox reduces headache days and is a cost-effective treatment for chronic migraine in Sweden and Norway.

Real-life use of onabotulinumtoxinA reduces healthcare resource utilization in individuals with chronic migraine: the REPOSE study

“…When compared with oral migraine preventive medications, onabotulinumtoxinA was associated with a significantly lower likelihood of headache-related emergency department visits and hospitalizations in a large, United States healthcare claims database study [ 31 ]. Additionally, cost-effectiveness analyses have shown that onabotulinumtoxinA is a cost-effective treatment for chronic migraine in the UK [ 20 , 32 ], Sweden and Norway [ 33 ], and Italy [ 34 ].…”

Erenumab Decreases Headache-Related Sick Leave Days and Health Care Visits: A Retrospective Real-World Study in Working Patients with Migraine

“…Migraine is globally among the leading causes of disability according to the number of years lived with disability metric [1]. This neurological disease particularly affects people in their prime working years and is not only associated with decreased quality of life but also with work impairment resulting in a significant economic burden on societies [2][3][4][5]. Several studies have demonstrated the association between migraine and an increased number of sick leave days, productivity loss and increased health care resource use [2,[6][7][8].…”

“…This neurological disease particularly affects people in their prime working years and is not only associated with decreased quality of life but also with work impairment resulting in a significant economic burden on societies [2][3][4][5]. Several studies have demonstrated the association between migraine and an increased number of sick leave days, productivity loss and increased health care resource use [2,[6][7][8]. In one survey, 70% of migraine patients reported that migraine had affected their working life, and 60% of responders reported to have missed at least 1 day of work in the last month due to migraine, with an average of 4.5 days missed in the last month [3].…”

“…Indirect costs resulting from absenteeism and productivity loss are the main contributors to the economic burden of migraine and could represent as much as 80-90% of the economic burden of the disease [2,7,8]. The detrimental impact of migraine on the ability to work increases with disease severity, with the highest burden observed in patients with chronic migraine and those for whom multiple prophylactic treatments have failed [3,6,8,9].…”

The effectiveness of screening for major cardiovascular risk factors in the population of small towns in Poland

“…Patients can still use the medication if they still have headache recurrence (botulinum toxin A injection into masseter muscle) [19]. The presence of these symptoms in the early postoperative period, in which we often observe edematous changes in the nose, should not worry either the patient or the surgeon.…”