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The medical care utilization and costs associated with migraine headache

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Abstract

OBJECTIVE: To describe the medical care use and costs associated with migraine.

DESIGN: Retrospective case-control design in which migraine case status was ascertained via validated telephone interview and linked with comprehensive claims data. Unadjusted and adjusted use and cost differences by migraine status were evaluated using exponential score tests and generalized estimating equations.

SETTING AND PATIENTS: We interviewed 8,579 individuals to identify migraine cases (N=1,265) and a random sample of nonmigraine controls (N=1,178) among eligible health plan enrollees aged 18 to 55.

MEASURES: Survey responses were used to categorize individuals meeting the International Headache Society’s diagnostic criteria for migraine with or without aura as migraine cases and to collect information on comorbid psychiatric symptoms. Claims data were used to compile annual medical and pharmaceutical use and costs, presence of migraine diagnosis, and other diagnosed comorbidities.

RESULTS: Interview-ascertained migraine cases used more outpatient visits (9.1 vs 6.8; P<.01), were more likely to be seen in the emergency department (20.7% vs 17.6%; P<.05), and were admitted to the hospital more (4.5% vs 2.8%; P<.05) compared to nonmigraine controls. Cases incurred significantly higher medical care costs ($2,761 vs $2,064; P<.01). Multivariable model results indicate that much of this increase in costs is due to the presence of major depressive symptoms as well as other diagnosed comorbidities that are more common among those with migraine.

CONCLUSIONS: By combining validated telephone survey information to identify migraine cases and controls with comprehensive claims data, we found migraine cases incur higher medical care costs compared to controls. These increased costs are associated with the presence of psychiatric symptoms and other comorbidities.

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References

  1. Stewart WF, Lipton RB, Liberman J. Variation in migraine prevalence by race. Neurology. 1996;47:52–9.

    PubMed  CAS  Google Scholar 

  2. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41:646–57.

    Article  PubMed  CAS  Google Scholar 

  3. Lipton RB, Stewart WF, Kolodner KB, Liberman JN. Epidemiology and patterns of health care use for migraine in the United States. Headache. 1999;39:65–6.

    Google Scholar 

  4. Hu XH, Markson LE, Lipton RB, Stewart WF, Berger ML. Burden of migraine in the United States: disability and economic costs. Arch Intern Med. 1999;159:813–8.

    Article  PubMed  CAS  Google Scholar 

  5. Stang PE, Osterhaus JT, Celentano DD. Migraine. Patterns of healthcare use. Neurology. 1994;44(6 suppl 4):S47-S55.

    PubMed  CAS  Google Scholar 

  6. Kolodner K, Lipton RB, Elston Lafata J, et al. Pharmacy and medical claims data identified migraine sufferers with high specificity but modest sensitivity. J Clin Epidemiol. 2004. In press.

  7. Lipton RB, Diamond S, Reed M, Diamond ML, Stewart WF. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache. 2001;47:638–45.

    Article  Google Scholar 

  8. Celentano DD, Stewart WF, Lipton RB, Reed ML. Medication use and disability among migraineurs: a national probability sample survey. Headache. 1992;32:223–8.

    Article  PubMed  CAS  Google Scholar 

  9. Stewart WF, Lipton RB, Whyte J, et al. An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology. 1999;53:988–94.

    PubMed  CAS  Google Scholar 

  10. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders: cranial neuralgias and facial pain. Cephalalgia. 1998;8:19–28.

    Google Scholar 

  11. Stewart WF, Lipton RB, Kolodner KB, Sawyer J, Lee C, Liberman JN. Validity of the Migraine Disability Assessment (MIDAS) score in comparison to a diary-based measure in a population sample of migraine sufferers. Pain. 2000;88:41–52.

    Article  PubMed  CAS  Google Scholar 

  12. Stewart WF, Lipton RB, Sawyer J. A multi-national study to assess the reliability of the migraine disability assessment (MIDAS) score. Headache. 1998;38:407.

    Google Scholar 

  13. Ware JE, Gandek B. The SF-36 health survey: development and use in mental health and the IQOLA Project. Int J Ment Health. 1994;23:49–73.

    Google Scholar 

  14. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–44.

    Article  PubMed  CAS  Google Scholar 

  15. Melfi CA, Croghan TW. Use of claims data for research on treatment and outcomes of depression care. Med Care. 1999;374(4 suppl):AS77-AS80.

    Article  Google Scholar 

  16. Simon G, Ormel J, VonKorff M, Barlow W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry. 1995;152:352–7.

    PubMed  CAS  Google Scholar 

  17. Harman JS, Rollman BL, Hanusa BH, Lenze EJ, Shear MK. Physician office visits of adults for anxiety disorders in the United States, 1985–1998. J Gen Intern Med. 2002;17:165–72.

    Article  PubMed  Google Scholar 

  18. Deyo RA, Taylor VM, Diehr P, et al. Analysis of automated administrative and survey databases to study patterns and outcomes of care. Spine. 1994;19(suppl 18):2083S-2091S.

    Article  PubMed  CAS  Google Scholar 

  19. Schneeweiss S, Seeger JD, Maclure M, Wang PS, Avorn J, Glynn RJ. Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol. 2001;154:854–64.

    Article  PubMed  CAS  Google Scholar 

  20. Savage IR. Contributions to the theory of rank order statistics—the two sample case. Ann Math Stat. 1956;27:590–615.

    Google Scholar 

  21. Duan N, Manning WG, Morris CN, Newhouse JP. A comparison of alternative models for the demand for medical care. J Bus Econ Stat. 1983;1:115–26.

    Article  Google Scholar 

  22. Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ. 2001;20:461–94.

    Article  PubMed  CAS  Google Scholar 

  23. Breslau N, Schultz LR, Stewart WF, Lipton RB, Lucia VC, Welch KM. Headache and major depression: is the association specific to migraine? Neurology. 2000;54:308–13.

    PubMed  CAS  Google Scholar 

  24. Breslau N. Migraine comorbidity with stroke, epilepsy and major depression. In Olesen J, Steiner TJ, Lipton RB, eds. Reducing the Burden of Headache. Oxford: Oxford University Press; 2003:164–72.

    Google Scholar 

  25. Clouse JC, Osterhaus JT. Healthcare resource use and costs associated with migraine in a managed healthcare setting. Ann Pharmacother. 1994;28:659–64.

    PubMed  CAS  Google Scholar 

  26. Edmeads J, Mackell JA. The economic impact of migraine: an analysis of direct and indirect costs. Headache. 2002;42:501–9.

    Article  PubMed  Google Scholar 

  27. Linet MS, Celentano DD, Stewart WF. Headache characteristics associated with physician consultation: a population-based survey. Am J Prev Med. 1991;7:40–6.

    PubMed  CAS  Google Scholar 

  28. Lipton RB, Stewart WF, Sawyer J, Edmeads JG. Clinical utility of an instrument assessing migraine disability: the Migraine Disability Assessment (MIDAS) questionnaire. Headache. 2001;41:854–61.

    PubMed  CAS  Google Scholar 

  29. Lipton RB, Stewart WF, Celentano DD, Reed ML. Undiagnosed migraine headaches. A comparison of symptom-based and reported physician diagnosis. Arch Intern Med. 1992;152:1273–8.

    Article  PubMed  CAS  Google Scholar 

  30. Von Korff M, Wagner EH, Dworkin SF, Saunders KW. Chronic pain and use of ambulatory health care. Psychosom Med. 1991;53:61–79.

    Google Scholar 

  31. Stewart WF, Lipton RB. Migraine headache: epidemiology and health care utilization. Cephalalgia. 1993;13(suppl 12):41–6.

    PubMed  Google Scholar 

  32. Rasmussen BK, Olesen J. Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia. 1992;12:221–8.

    Article  PubMed  CAS  Google Scholar 

  33. Lipton RB, Stewart WF, Von Korff M. The burden of migraine. A review of cost to society. Pharmacoeconomics. 1994;6:215–21.

    PubMed  CAS  Google Scholar 

  34. Von Korff M, Stewart WF, Lipton RB. Assessing headache severity. New directions. Neurology. 1994;44(6 suppl 4):S40-S46.

    Google Scholar 

  35. Ramadan NM, Silberstein S, Freitag F, Gilbert TT, Frishberg BM. Evidence based guidelines for migraine headache in the primary care setting: pharmacological management for prevention of migraine. Available at: http://www.neurology.org. Accessed March 1, 2003.

  36. Lipton RB, Silberstein S. Why study the comorbidity of migraine? Neurology. 1994;44:28–32.

    Google Scholar 

  37. Silberstein S, Lipton RB. Chronic daily headache, including transformed migraine, chronic tension type headache and medication overuse. In: Silberstein S, Lipton RB, Dalessio DJ, eds. Wolff’s Headache and other Head Pain. New York, NY: Oxford University Press; 2001:247–82.

    Google Scholar 

  38. Centers for Disease Control and Prevention. Colorectal cancer test use among persons aged ≥ 50 years—United States, 2001. MMWR. 2003;52:193–6.

    Google Scholar 

  39. Davies GM, Santanello N, Lipton R. Determinants of patient satisfaction with migraine therapy. Cephalalgia. 2000;20:554–60.

    Article  PubMed  CAS  Google Scholar 

  40. Dasbach EJ, Carides GW, Gerth WC, Santanello NC, Pigeon JG, Kramer M. Work and productivity loss in the rizatriptan multiple attack study. Cephalalgia. 2000;29:830–4.

    Article  Google Scholar 

  41. Cady RK, Sheftell F, Lipton RB, Kwong WJ, O’Quinn S. Economic implications of early treatment of migraine with sumatriptan tablets. Clin Ther. 2001;23:284–91.

    Article  PubMed  CAS  Google Scholar 

  42. Stang P, Cady R, Batenhorst A, Hoffman L. Workplace productivity. A review of the impact of migraine and its treatment. Pharmacoeconomics. 2001;19:231–44.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Center for Health Services Research, Henry Ford Health System, One Ford Place, Suite 3A, 48202, Detroit, MI

    Jennifer Elston Lafata PhD, Christina Moon MA & Laila Poisson MS

  2. IMR, An AdvancePCS Company, Hunt Valley, Md

    Carol Leotta PhD & Ken Kolodner PhD

  3. Departments of Epidemiology and Social Medicine, and Neurology, Albert Einstein College of Medicine, New York, NY

    Richard B. Lipton MD

Authors
  1. Jennifer Elston Lafata PhD
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  2. Christina Moon MA
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  3. Carol Leotta PhD
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  4. Ken Kolodner PhD
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  5. Laila Poisson MS
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  6. Richard B. Lipton MD
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Corresponding author

Correspondence to Jennifer Elston Lafata PhD.

Additional information

This research was supported by AstraZeneca Pharmaceuticals.

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Lafata, J.E., Moon, C., Leotta, C. et al. The medical care utilization and costs associated with migraine headache. J GEN INTERN MED 19, 1005–1012 (2004). https://doi.org/10.1111/j.1525-1497.2004.30021.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30021.x

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