Impact of Triptan Insufficient Response on Medication Use, Health Care Utilization, and Costs: A Retrospective Claims Study
Krutika Parikh1, Richard Lipton2, Amanda Howarth3, Lauren Wilson3, Amit Bodhani1, Molly Duan1, Jessica Ailani4
1AbbVie, 2Albert Einstein College of Medicine, 3Genesis Research Group, 4Medstar Georgetown University
Objective:
This study aimed to assess medication use and migraine-specific healthcare resource use (HCRU) and costs in patients with a potential insufficient response to triptans compared to patients who continue on triptans.
Background:
Patients who do not adequately respond to triptans may have suboptimal outcomes.
Design/Methods:
Adult migraine patients with ≥1 triptan claim (index date) were identified from the MarketScan Commercial Database (2019 – 2022). Patients with ≥1 triptan claim in the 12 months pre-index were excluded. Two cohorts were formed: triptan continuers (patients with >1 triptan refill AND 0 fills for any non-triptan acute migraine medications) and potential triptan insufficient responders (TIR) (patients with 0/1 triptan refill AND ≥1 fill for any non-triptan acute medication).
Results:
Among the 30,477 included patients, 12,858 (42.2%) were classified as triptan continuers and 9,353 (30.7%) as TIR. Substantial non-triptan acute use was observed among TIR patients over the 24-month follow-up period: migraine-related (prescription claim within 15 days of a migraine diagnosis) NSAIDs (48%), opioids (36%), and barbiturates (18%) as well as rimegepant (18%) and ubrogepant (16%). During the first 12 months post-index, a higher proportion of TIR patients had a migraine-related inpatient visit (2.9% vs 0.5%) or emergency department visit (8.4% vs 2.3%) compared to triptan continuers. Mean migraine-related outpatient office visits (3.51 vs 1.96) were also higher in the TIR cohort compared to triptan continuers (P < .01). Adjusted migraine-related total medical costs were $1,800 higher (mean ratio [MR], 3.50 [95% CI, 2.82-3.96]) and prescription costs were $1,158 higher (MR, 3.12 [95% CI, 2.91-3.35]) during the first 12-months post-index in the TIR cohort compared with triptan continuers. Similar patterns in HCRU and cost were observed in months 13-24 of follow-up.
Conclusions:
When compared with triptan continuers, those with a potential insufficient response to triptans incurred significantly higher total migraine related and medication-related costs.
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