Economic Burden Increased with Number of Treatment Failures in Migraine Patients - A Retrospective Claims Database Analysis in the United States
Lawrence Newman1, Jasper Huels2, Pamela Vo2, Lujia Zhou3, Cristina Lopez Lopez2, Andy Cheadle4, Melvin Olson2, Juanzhi Fang4
1NYU Langone Health, Headache Division, New York, USA, 2Novartis Pharma AG, Basel, Switzerland, 3KMK Consulting Inc. New Jersey, USA, 4Novartis Pharmaceuticals Corporation, East Hanover, USA
To characterize health-care resource utilization (HCRU) and associated costs among migraine patients, categorized by number of preventive treatment failures (TF; 1TF, 2TF, ≥3TF).  
Migraine is associated with substantial economic burden. However, information on burden associated with failed preventive treatments among migraine patients is limited.
This study used the IBM MarketScan® Commercial and Medicare Supplemental database to identify newly diagnosed migraine patients for the period of January 1st, 2011 to June 30th, 2015. The number of TF was identified during the 2 years following initial migraine diagnosis, and HCRU and associated costs assessed in 12 months post-index. The index for 1TF patients was the date of their 2nd preventive treatment (PT) initiation, 2TF their 3rd and ≥3TF patients their 4th PT initiation. 
Among 44,181 incident migraine patients, who had failed preventive treatments, 61.4% (27,112) had 1TF, 24% (10,583) had 2TF and 14.7% (6,486) had ≥3TF, respectively. The total medical (emergency room [ER] + inpatient [IP] + outpatient [OP]) per-patient cost increased with increase in number of TF (1TF: $10,329; 2TF: $13,774; ≥3+TF: $35,392). On adding prescription drug costs, the total health-care costs also increased with number of TF (1TF: $13,946; 2TF: $18,685; ≥3TF: $41,864). Similarly, the per-patient annual health-care provider visits increased with increase in number of TF. The number of ER visits/ year were 0.54, 0.69, and 1.02 for 1TF, 2TF, and ≥3TF patients respectively, while those for IP were 0.46, 0.59, and 0.97. A similar trend was seen with outpatient visits (office visits: 1TF: 9.47, 2TF: 11.24, ≥3TF: 14.26, other visits: 1TF: 13.15, 2TF: 15.73, ≥3TF: 19.96).
The HCRU and associated costs were highest for ≥3TF patients, followed by 2TF and 1TF patients, suggesting that increase in TF is associated with increase in economic burden.