ABSTRACT
OBJECTIVE: We examined the costs and benefits of introducing migraine nurses into primary care. BACKGROUND: Migraine is one of the most costly neurological diseases. METHODS: We analyzed data from our earlier nonrandomized cohort study comparing an intervention group of 141 patients, whose care was supported by nurses trained in migraine management, and a control group of 94 patients receiving usual care. Estimates of per-person direct costs were based on nurses' salaries and referrals to neurologists. Indirect costs were estimated as lost productivity, including numbers of days of absenteeism or with <50% productivity at work due to migraine, and notional costs related to lost days of household activities or days of <50% household productivity. Analysis was conducted from the payer's perspective. RESULTS: After 9 months the direct costs were 281.11 in the control group against 332.23 in the intervention group (mean difference -51.12; 95% CI: -113.20-15.56; P = .134); the indirect costs were 1985.51 in the control group against 1631.75 in the intervention group (mean difference 353.75; 95% CI: -355.53-1029.82; P = .334); and total costs were 2266.62 in the control group, against 1963.99 in the intervention group (mean difference 302.64; 95% CI: -433.46-1001.27; P = .438). When costs attributable to lost household productivity were included, total costs increased to 6076.62 in the control group and 5048.15 in the intervention group (mean difference 1028.47; 95% CI: -590.26-2603.67; P = .219). CONCLUSION: Migraine nurses in primary care seemed in this study to increase practice costs but decrease total societal costs. However, it was a nonrandomized study, and the differences did not reach significance. For policy-makers concerned with headache-service organization and delivery, the important messages are that we found no evidence that nurses increased overall costs, and investment in a definitive study would therefore be worthwhile.
Subject(s)
Cost-Benefit Analysis , Migraine Disorders/economics , Migraine Disorders/therapy , Nurses/economics , Primary Health Care/economics , Primary Health Care/methods , Absenteeism , Adult , Cost of Illness , Female , Follow-Up Studies , Health Care Costs , Humans , Male , Netherlands , Neurologists/economics , Referral and Consultation/economics , Salaries and Fringe Benefits , Sex Factors , Time FactorsABSTRACT
INTRODUCTION: Migraine is a common disorder with a high burden. Adequate treatment results in improvement of quality of life. Migraine patients are mainly treated by general practitioners (GPs), but there is still room for improvement. This study investigated whether primary care nurses could improve the treatment of migraine patients compared to usual care as provided by the GPs. PARTICIPANTS AND METHODS: We conducted a non-randomized controlled prospective trial in 235 patients diagnosed with migraine with or without aura according to ICHD-II criteria, aged between 18 and 65 years. Patients with migraine treated only by their GP were compared to management by a nurse supervised by a GP. RESULTS: In the intervention group, fewer migraine patients were referred to a neurologist (p < 0.001). The reduction in monthly migraine days compared to baseline was more apparent in the intervention group at six (p = 0.09) and nine months (p = 0.006). There was no significant change in dichotomized HIT score (p = 0.076). Change in satisfaction of patients did not differ significantly (p = 0.070). CONCLUSIONS: The care administered by a headache nurse in the primary care setting supervised by a GP resulted in fewer referrals to the neurologist and more migraine-free days per month, but no change in HIT score. There was no difference in satisfaction scores between both groups.
