Service use and costs for people with headache: a UK primary care study

Abstract

This paper aims to estimate the service and social costs of headache presenting in primary care and to identify predictors of headache costs. Patients were recruited from GP practices in England and service use and lost employment recorded. Predictors of cost were identified using regression models. Service and social costs were available on 288 and 282 patients, respectively. Average service costs over 3 months were £117 whilst total costs (including lost production) were £582. Patients referred to neurologists had service costs that were £82 higher than those not referred (90% CI £36–£128). Costs including lost employment were higher by £150, but this was not significant (90% CI -£139–£439). The annual mean service and social costs, weighted to represent population rates of referral, were £468 and £2328, respectively. Higher costs were significantly related to pain. Age was linked to higher service costs and lower social costs. The figures extrapolated to the whole of the UK suggest £956 million due to service use and £4.8 billion including lost employment. These are likely to be underestimates because many people experiencing headaches do not consult their GP.

Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults

“…2 The study should follow rigorous methods, employ standardised outcome measure with long-term followup, use an active comparator, with CBT based on step-wise treatment to enable the identification of the specific component/components that may be responsible for reducing any improvements in headaches/ migraines symptoms.…”

Headache: The Patient’s View

“…Scanning for headache alone has a low predictive yield. On the other hand, referral to a neurologist for an expert assessment and access to scanning is more expensive [6]. Headache is one of the commonest symptoms reported, and 4% of adults consult their primary care physician for it each year [7].…”

Headache Diagnosis in Primary Care

“…If FPs are able to distinguish low from high frequency headache, this may help them to identify and manage the associated disability, psychological co-morbidity and cost associated with headache. Addressing these issues in primary care may have health gains for patients, enhance patient satisfaction, reduce referral, and reduce costs for patients and society [5]. This remains to be evaluated.…”

“…Patients were asked to agree if they were satisfied and the 5-point Likert scale was anchored at 1 = strongly disagree and 5 = strongly agree. This scale was then dichotomised to disagree (1-3) and agree (4)(5). Research associates collected information on the FPs' diagnosis and consultation frequency in the previous 3 months.…”

“…Reasons FPs gave for referring to neurologists included the patient's anxiety about brain tumour, and the FP's lack of confidence in diagnosis [4]. We previously estimated UK service costs for people consulting with headache are £956 million and the total costs including lost production are £4.8 billion [5].…”