Healthcare Resource Use and Costs Associated with the Misdiagnosis of Migraine
Jae Rok Kim1, Tae Jin Park1, Maria Agapova2, Andrew Blumenfeld3, Jonathan Smith1, Darshini Shah4, Beth Devine2
1AbbVie, 2University of Washington CHOICE Institute, 3The Los Angeles and San Diego Headache Centers, 4AbbVie Inc
Objective:
Compare HCRU (health care resource utilization) and healthcare costs in patients with migraine with or without a history of misdiagnosis.
Background:
Despite the high prevalence of migraine, migraine is commonly misdiagnosed. The healthcare resource use and cost burden of a misdiagnosis is unknown.
Design/Methods:
This retrospective cohort study identified adults with an incident migraine diagnosis from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases between June 2018-2019. Patients with a diagnosis of commonly considered misdiagnoses (headache, sinusitis, or cervical pain) before their migraine diagnosis were classified as misdiagnosed-correctly diagnosed cohort (MD-CD). Patients in the MD-CD cohort were potentially misdiagnosed, then eventually received a correct diagnosis. Patients without a history of commonly considered misdiagnoses prior to their migraine diagnosis were classified as correctly diagnosed cohort (CD). HCRU and healthcare costs were assessed in the period before migraine diagnosis and compared between the cohorts. Outcomes were reported as per patient per month (PPPM) and compared with incidence rate ratios (IRR) adjusted for age, sex, region, plan type, and comorbidities.
Results:
29,147 CD and 3,841 MD-CD patients met inclusion criteria. Adjusting for baseline characteristics, MD-CD patients had statistically significant higher rates of inpatient admissions (IRR:1.61, 95% CI 1.47–1.74), emergency department (ED) visits (IRR:1.92, 95% CI 1.82–2.03), neurologist visits (IRR:5.92, 95% CI 5.37–6.54), and non-neurologist outpatient visits (IRR:1.67, 95% CI 1.62–1.72) and prescription fills (IRR:1.52, 95% CI 1.47–1.57) compared to CD patients. MD-CD patients had statistically significant higher rates of healthcare cost accrual for inpatient admissions (IRR:2.54, 95% CI 2.42-2.62), ED visits (IRR:2.27, 95% CI 2.20–2.32), neurologist visits (IRR:4.33, 95% CI 3.81–4.52), non-neurologist outpatient visits (IRR:2.06, 95% CI 1.91–2.23), and prescription fills (IRR:1.36, 95% CI 1.13–1.63) compared to CD patients.
Conclusions:
Patients with migraine with a history of misdiagnoses have higher rates of HCRU, and cost accrual versus those without such history.