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Cost of Health Care Among Patients With Chronic and Episodic Migraine in Canada and the USA: Results From the International Burden of Migraine Study (IBMS)

Authors

  • Michael Stokes MPH,

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  • Werner J. Becker MD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Richard B. Lipton MD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Sean D. Sullivan PhD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Teresa K. Wilcox PhD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Leandra Wells PhD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Aubrey Manack PhD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Irina Proskorovsky MSc,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Jonathan Gladstone MD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Dawn C. Buse PhD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Sepideh F. Varon PhD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Peter J. Goadsby MD, PhD,

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Andrew M. Blumenfeld MD

    1. From United BioSource Corporation, Dorval, QC, Canada (M. Stokes); and Bethesda, MD, USA (T.K. Wilcox and I. Proskorovsky); University of Calgary, Calgary, AB, Canada (W.J. Becker); Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.B. Lipton and D.C. Buse); University of Washington, Seattle, WA, USA (S.D. Sullivan); Allergan Canada, Markham, ON, Canada (L. Wells); Allergan, Inc., Irvine, CA, USA (A. Manack and S.F. Varon); Gladstone Headache Clinic, Toronto, ON, Canada (J. Gladstone); Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA (P.J. Goadsby); The Neurology Center, Encinitas, CA, USA (A.M. Blumenfeld).
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  • Role of the funding source: This study was funded by Allergan, Inc. The study sponsor was involved in the study design, data collection, data analysis, data interpretation, and the writing of the article. The sponsor and corresponding authors directed the research design and reviewed all major research decisions (ie, study instruments, sampling, and analyses). The authors had full access to all data and had final responsibility for the decision to submit for publication.

  • Conflict of Interest: S.F.V., A.M., and L.W. are employees of Allergan, Inc. A.M.B. has received research grants from Allergan, Pfizer, GlaxoSmithKline, and Medtronic, has received honoraria from Allergan, Pfizer, GlaxoSmithKline, Merck, Ortho-McNeil, and Medtronic, and has consultancy agreements with Allergan, Pfizer, and GlaxoSmithKline. M.S., I.P., and T.K.W. are employees of United BioSource Corporation. D.C.B. has received honoraria from Endo, Merck, Iroko, and MAP Pharmaceuticals, and has consultancy agreements with Endo and Allergan Pharmaceuticals. J.G. has been a consultant and/or participated in advisory boards for Allergan, Athena Diagnostics, Johnson & Johnson/McNeil Consumer Healthcare, Merck, Pfizer, Procter & Gamble, and Teva, has received honoraria for CME programs from Athena Diagnostics, Johnson & Johnson/McNeil Consumer Healthcare, Merck, Pfizer, and Teva, and holds stocks in Allergan. P.J.G. has received research grants from MSD, Neuralieve, GlaxoSmithKline, and Johnson & Johnson, and has received honoraria from and has consultancy agreements with Allergan, Almirall, Boston Scientific, Eli Lilly, Endo, MAP, Medtronic, Minster, MSD, Neuralieve, Neuraxon, and NTP. R.B.L. has received research grants from Advanced Bionics, Allergan, GlaxoSmithKline, Minster, Merck, Neuralieve, Novartis, Ortho-McNeil, Pfizer, and ProEthics/Kowa, has received honoraria from Allergan, AstraZeneca, GlaxoSmithKline, Merck, Novartis, OrthoMcNeil, and Pfizer, and has consultancy agreements with Advanced Bionics, Allergan, Boehringer Ingelheim, Bristol-Myers Squibb, Cierra, Endo, Neuralieve, Novartis, Ortho-McNeil, Pfizer, Pozen, and ProEthics/KOWA. W.J.B. has served on medical advisory boards for and received speaker's honoraria from Allergan, Merck, and Johnson & Johnson, and has performed clinical trials research for Allergan, Medtronic, Merck, and AGA Medical. S.D.S. has received research funding from Allergan.

M. Stokes, United BioSource Corporation, 185 Dorval Avenue, Suite 500, Dorval, QC H9S 5J9, Canada, email: michael.stokes@unitedbiosource.com

Abstract

(Headache 2011;51:1058-1077)

Objective.— To evaluate and compare healthcare resource use and related costs in chronic migraine and episodic migraine in the USA and Canada.

Background.— Migraine is a common neurological disorder that produces substantial disability for sufferers around the world. Several studies have quantified overall costs associated with migraine in general, with recent estimates ranging from $581 to $7089 per year. Although prior studies have characterized the clinical and humanistic burden of chronic migraine relative to episodic migraine, to the best of our knowledge only 1 previous study has compared chronic migraine and episodic migraine healthcare costs. The purpose of this study was to quantify and compare the direct medical costs of chronic migraine and episodic migraine using medical resource use data collected as part of the International Burden of Migraine Study.

Methods.— Cross-sectional data were collected from respondents in 10 countries via a Web-based survey. Respondents were classified as chronic migraine (≥15 headache days/month) or episodic migraine (<15 headache days/month). Data collection included socio-demographic and clinical characteristics and medical resource use for headache (clinician and emergency department visits and hospitalizations over the preceding 3 months and medications over the preceding 4 weeks). Unit cost data were collected outside of the Web-based survey using publicly available sources and then applied to resource use profiles. Cost estimates are presented in 2010 US and Canadian dollars.

Results.— In this manuscript, the analysis included data from respondents with migraine in the USA (N = 1204) and Canada (N = 681). The most common medical services utilized by all respondents included headache-specific medication, healthcare provider visits, emergency department visits, and diagnostic testing. In the USA, approximately one-quarter (26.2%) of chronic migraine participants vs 13.9% of episodic migraine participants reported visiting a primary care physician in the preceding 3 months (P < .001). In Canada, one-half (48.2%) of chronic migraine participants had a primary care physician visit, compared with 12.3% of episodic migraine subjects (P < .0001). Total mean headache-related costs for participants with chronic migraine in the USA were $1036 (±$1334) over 3 months compared to $383 (±807, P < .001) for persons with episodic migraine. In Canada, total mean headache-related costs among chronic migraine subjects were $471 (±1022) compared to $172 (±920, P < .001) for episodic migraine subjects.

Conclusions.— Chronic migraine was associated with higher medical resource use and total costs compared to episodic migraine. Therapies that reduce headache frequency could become important approaches for containing or reducing headache-related medical costs.

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