Real-world assessment of concomitant opioid utilization and associated trends in patients with migraine.

Migraine is a debilitating condition that affects approximately 16% of adults and is the fifth leading cause of emergency department visits in the United States. There are several treatment options for migraines; opioids are frequently prescribed. Results from a recent study showed that more than half of the patients with chronic migraine and a third of the patients with episodic migraine received an opioid prescription in the past year. The American Headache Society recognizes the magnitude of this issue and is working to educate providers on the danger of prescribing opioids in the migraine population The objective of this article is to assess the utilization trends of prescription opioid products and evaluate the impact of opioid utilization on healthcare costs in this patient population. This retrospective claims database analysis used real-world medical claims from multiple health plans. The study period was from January 1, 2009, to September 30, 2017. Patients were included if they were 18 years or older and continuously enrolled in the study period for at least 3 years. Patients were included in the migraine cohort if they had any diagnosis of migraine headache during the study period, while patients without a headache related diagnosis were included in the control cohort. Control patients were propensity matched 1:1 to migraine patients. Discrete (count) data are represented by frequencies and percentages. Continuous results are presented as means, medians, and standard deviations. In the study, 107,216 patients met the inclusion criteria, with 53,608 assigned to each cohort. In the migraine and control cohorts, respectively, 28% and 11% were prescribed opioids. In both cohorts, a majority of the patients were female (81.8%). In both cohorts, opioid use was associated with higher total costs compared with patients who were not prescribed opioids: $82,007 for 200 morphine milligram equivalents (MME)/day or more versus $19,792 for no opioid in patients with migraine; and $54,200 for 200 MME/day or more versus $12,060 for no opioid use in control patients; P <.0001. Patients with more than 2 comorbidities who were prescribed opioids had higher costs than patients with more than 2 comorbidities who were not prescribed opioids and patients with less than 2 comorbidities who were prescribed opioids ($65,980, $32,152, and $35,964, respectively, for patients with migraine, and $52,883, $24,641, and $35,748, respectively, for control patients; P <.0001). Patients with migraine have more than twice the healthcare costs as patients without migraines. The additional increase in healthcare costs in patients with migraine who use opioids for treatment and/or have 2 or more comorbidities is significant. Control of the pain associated with migraine, specifically among those with multiple comorbid conditions, may contribute to substantial reductions in healthcare costs.

Real-world health plan claims analysis of differences in healthcare utilization and total cost in patients suffering from cluster headaches and those without headache-related conditions.

BACKGROUND: According to the World Health Organization, headache disorders are underappreciated by many health systems. These disorders have a substantial impact on quality of life, yet the true correlation between headache conditions and increased total healthcare utilization is not well understood. This study further explores the impact of headache conditions on healthcare utilization. OBJECTIVES: To assess differences in healthcare utilization and total cost in patients suffering from cluster headaches (CH) compared with patients without headache-related conditions. METHODS: Medical and pharmacy claims data from 4 regional health plans were used to evaluate differences in healthcare utilization and cost in patients with a diagnosis code for CH (chronic, episodic, or unspecified) from International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification compared with a control group of patients without headache-related conditions. Qualifying patients were aged at least 18 years and continuously eligible for their health plan for 3 consecutive years during the study period (January 1, 2009-December 31, 2015). The first date with a diagnosis of CH was considered the index date and the subsequent 3 years of claims data were used for this retrospective analysis. The CH cohort was matched with controls using propensity score matching. Differences between cohorts (CH vs control) were assessed with t test or Fisher's exact test as appropriate. RESULTS: A total of 4174 patients with diagnosis codes for CH met the study criteria and were matched 1:1 with controls (gender: 48% male; mean age: 47 years; mean Charlson Comorbidity Index score: 0.30). Mean medical costs per patient in the CH cohort during the 3-year measurement period were 155% higher than those of the control group ($25,805 vs $10,140, respectively). Unique encounters and cost per patient by medical services type for the CH cohort compared with the control group were as follows (encounters [costs]): emergency department: 2151 ($1986) versus 962 ($1268); hospital inpatient: 900 ($7312) versus 253 ($8528); hospital outpatient: 3422 ($12,459) versus 2141 ($7644); physician office: 4113 ($7379) versus 4089 ($3672); home infusion/specialty medications: 817 ($4977) versus 427 ($1720). Visit counts per patient were significantly higher for CH patients in all categories. Mean pharmacy costs per patient for the CH cohort were more than double that of the control group ($9197 vs $4368), with these patients 2.3 times as likely to fill a prescription for an opioid. CONCLUSIONS: The results of this analysis show that CH patients utilize healthcare resources at a significantly higher rate and cost the healthcare system significantly more than similar patients without headache-related conditions. There is an unmet need for new treatment modalities in this patient population to improve outcomes and contain cost.