Direct Costs of Preventive Headache Treatments: Comparison of Behavioral and Pharmacologic Approaches

Abstract

Objectives This study provides preliminary data and a framework to facilitate cost comparisons for pharmacologic versus behavioral approaches to headache prophylactic treatment. Background There are few empirical demonstrations of cumulative costs for pharmacologic and behavioral headache treatments, and there are no direct comparisons of short and long range (5 year) costs for pharmacologic versus behavioral headache treatments. Methods Two separate pilot surveys were distributed to a convenience sample of behavioral specialists and physicians identified from the membership of the American Headache Society. Costs of prototypical regimens for Preventive Pharmacologic Treatment (PPT), Clinic-Based Behavioral Treatment (CBBT), Minimal-Contact Behavioral Treatment (MCBT), and Group Behavioral Treatment (GBT) were assessed. Each survey addressed total cost accumulated during treatment (i.e., intake, professional fees) excluding costs of acute medications. The total costs of preventive headache therapy by type of treatment were then evaluated and compared over time. Results During the initial months of treatment, PPT with inexpensive mediations (< .75¢/day) represents the least costly regimen and is comparable to MCBT in expense until 6 months. After 6 months, PPT is expected to become more costly, particularly when medication cost exceeds .75¢ a day. When using an expensive medication (>3$/day), preventive drug treatment becomes more expensive than CBBT after the first year. Long term, and within year one, MCBT was found to be the least costly approach to migraine prevention. Conclusions Through year 1 of treatment, inexpensive prophylactic medications (such as generically available beta-blocker or tricyclic antidepressant medications) and behavioral interventions utilizing limited delivery formats (minimal-contact behavior treatment) are the least costly of the empirically validated interventions. This analysis suggests that, relative to pharmacologic options, limited format behavioral interventions are cost competitive in the early phases of treatment and become more cost efficient as the years of treatment accrue.

Migraine and its psychiatric comorbidities

“…They may be less costly than pharmacological interventions 123. As stated previously, studies have shown that combination pharmacological–behavioural therapy is most effective for migraine treatment 34 37 124 125.…”

Psychological interventions for migraine: a systematic review

“…Since Goslin et al [8] last reviewed the literature in 1999, the most favoured behavioural approach to migraine has been CBT + RT, in particular, minimal-contact interventions. These low intensity interventions demonstrated a modest efficacy in migraine reduction, which is of particular relevance because, such approaches are likely to be less costly, hence, potentially more cost-effective [43]. A recent paper provides some understanding of patients’ views using qualitative methods, with interviews [9, 44].…”

Psychological Approaches to Headache

“…25 CBT is time-and cost-effective compared with pharmacological preventive treatments. 147 It can be successfully delivered at home or with minimal therapist contact through technology-augmented interventions such as the telephone or Internet, and can be tailored to meet the needs of individual persons with headache. 24,148,149 Although CBT has demonstrated efficacy, a large proportion of participants in trials (roughly 40%) may not experience clinically significant reductions in migraine symptoms.…”