Pharmacoeconomics for migraine and headache researchers: basic concepts, methods and terminology

Abstract

Pharmacoeconomics, the application of health economics to pharmaceuticals, is an increasingly important part of the evaluation of any therapy. It is a response to limitations on the resources available for medical care, and the need to justify how we spend these resources for the public good. This review summarises some of the key issues in pharmacoeconomics, drawing examples from the literature on migraine or headaches. It describes how pharmacoeconomics is fundamentally comparative, and must be based on real world practice rather than on clinical trials. An important point is what outcomes in migraine might be used in such studies. The types of studies commonly encountered are detailed. These examples illustrate some of the limitations of the process: a risk of industry driven bias, and a draw of money into the areas evaluated (e. g., acute therapies) rather than those not considered (e. g., longterm therapies).

Onabotulinumtoxin A (ONA-BoNT/A) in the treatment of chronic migraine

“…In the USA, the aforementioned mean annual sub-costs of chronic migraine are as follows: $86.7, $498.4, $557.1, and $3,002.4, with a mean total annual cost of $4,144, and $187.2, $178, $127.3, and $1,040.4 in episodic migraine respectively, with a mean total annual cost of $1,533 [24]. In Canada, as well as in European countries, the proportions between the mean costs of treatment of chronic migraine and episodic migraine are similar [23,24]. According to the data of the Social Insurance Institution, in 2017, 97,349 sick leave days due to migraine were financed in Poland [25].…”

“…Pharmacoeconomics is an increasingly important part of the evaluation of migraine therapies [22,23]. Taking into account the therapeutic approach before the era of ONA-BoNT/A and anti-CGRP-mAbs/anti-CGRP-R-mAbs, such costs related to hospitalisations/ED visits, healthcare provider visits, procedures and medications in chronic migraineurs are globally three times as much as in patients with episodic migraine.…”

Starting Tutorials in headache medicine education

“…Last year, in an excellent pilot Tutorial by Tom Walley, attention was already focused on the understanding of basic pharmacoeconomics concepts applied to migraine [3]. His guidance into measurement of medical interventions in terms of costs (direct, indirect, intangible) and benefits, quantified according to both clinical and utility units, the starting point of any therapy evaluation, reached the final teaching aim.…”