Health Care Resource Utilization and Economic Burden in Patients Cycling Through Multiple Triptans for Migraines: A Retrospective Analysis
Jessica Ailani1, Krutika Parikh2, Amanda Howarth3, Lauren Wilson3, Molly Duan2, Amit Bodhani2, Richard B. Lipton4
1MedStar Georgetown University Hospital, 2AbbVie, 3Genesis Research Group, 4Albert Einstein College of Medicine
Objective:
Determine the triptan cycling burden by comparing medication use, MOH diagnoses, and migraine-specific HCRU and costs in patients treated with a single versus two or more triptans.
Background:
Poor efficacy and tolerability to triptans may result in increased use of other migraine treatments, HCRU, and costs.
Design/Methods:
This retrospective claims analysis used the MarketScan Databases(January 1, 2015-February 28, 2023). Patients ≥18yrs with migraines and ≥1 triptan prescription claim ≥January 1st, 2016, were divided into 2 cohorts: those continuing the same triptan (index fill with ≥1 refill) and those using ≥2 different triptans (≥1 fill index triptan, ≥1 fill different triptan) over a 24-month follow-up. The index date was the earliest triptan prescription claim. Patients with claims during 12-months pre-index were excluded. Descriptive statistics summarized baseline demographics and clinical characteristics. Chi-square tests compared post-index medication use. Regression models evaluated MOH, adjusted migraine-specific HCRU, and costs over a 24-month follow-up period.
Results:
Of 184,717 new triptan users, 91,406(49.5%) were in the 1 triptan cohort and 22,909(12.4%) were in the 2+ triptans cohort. In 1 triptan cohort, 32.1%, 18.1%, and 49.8% had 1, 2, and ≥3 refills, respectively. Patient demographics and clinical characteristics were similar between cohorts. 2+ triptans cohort had higher migraine-related acute treatment use excluding triptans (48.8% vs 29.6%) and preventive treatment use (83.1% vs 68.9%) versus 1 triptan cohort (all P<.001). Diagnosed MOH occurred in 3.5% and 1.1% of the 2+ and 1 triptan cohorts, respectively (odds ratio,2.98[95%CI,2.71-3.28]). Migraine-related ER, diagnostic imaging, and outpatient visits were 1.4, 1.3, and 1.4x higher in the 2+ triptan cohort. Adjusted migraine-related medical costs were $2,235 higher (mean ratio,1.88[95%CI,1.79-1.98]) and prescription costs were $1,939 higher (mean ratio,2.31[95%CI,2.23-2.41]) in the 2+ triptan cohort.
Conclusions:
Cycling through ≥2 triptans was associated with higher treatment use, more MOH diagnoses, more ER visits, more diagnostic imaging, more outpatient visits, and higher costs.
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