Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study

Abstract

Background Migraine represents a serious burden for national health systems. However, preventive treatment is not optimally applied to reduce the severity and frequency of headache attacks and the related expenses. Our aim was to assess the persistence to traditional migraine prophylaxis available in Spain and its relationship with the healthcare resource use (HRU) and costs. Methods Retrospective observational study with retrospective cohort design of individuals with migraine treated with oral preventive medication for the first time from 01/01/2016 to 30/06/2018. One-year follow-up information was retrieved from the Big-Pac™ database. According to their one-year persistence to oral prophylaxis, two study groups were created and describe regarding HRU and healthcare direct and indirect costs using 95% confidence intervals (CI). The analysis of covariance (ANCOVA) was performed as a sensitivity analysis. Patients were considered persistent if they continued on preventive treatment until the end of the study or switched medications within 60 days or less since the last prescription. Non-persistent were those who permanently discontinued or re-initiated a treatment after 60 days. Results Seven thousand eight hundred sixty-six patients started preventive treatment (mean age (SD) 48.2 (14.8) and 80.4% women), of whom 2,545 (32.4%) were persistent for 6 months and 2,390 (30.4%) for 12 months. Most used first-line preventive treatments were antidepressants (3,642; 46.3%) followed by antiepileptics (1,738; 22.1%) and beta-blockers (1,399; 17.8%). The acute treatments prescribed concomitantly with preventives were NSAIDs (4,530; 57.6%), followed by triptans (2,217; 28.2%). First-time preventive treatment prescribers were mostly primary care physicians (6,044; 76.8%) followed by neurologists (1,221; 15.5%). Non-persistent patients required a higher number of primary care visits (mean difference (95%CI): 3.0 (2.6;3.4)) and days of sick leave (2.7 (0.8;4.5)) than the persistent ones. The mean annual expenditure was €622 (415; 829) higher in patients who not persisted on migraine prophylactic treatment. Conclusions In this study, we observed a high discontinuation rate for migraine prophylaxis which is related to an increase in HRU and costs for non-persistent patients. These results suggest that the treatment adherence implies not only a clinical benefit but also a reduction in HRU and costs.

Association between clinician specialty and prescription of preventive medication for young adults with migraine: A retrospective cohort study

“…25,26 This discrepancy of women receiving more preventive medication prescriptions but reporting less frequent use of these medications is not fully understood but could be explained in part by high preventive medication discontinuation rates. 3,27 Our study also found that the frequency of neurology visits was associated with a higher likelihood of preventive medication prescriptions, which is consistent with other studies. 24 This may be explained by the fact that patients with higher disease severity (and therefore candidates for preventive medication) are more likely to In our study, having a psychiatric comorbidity was not associated with the use of preventive medications; however, there is a known association between having comorbid psychiatric disease, specifically anxiety and depression, and having greater headache-related disability.…”

“…Despite this, in survey studies, women are less likely, compared to men, to report the use of preventive medications 25,26 . This discrepancy of women receiving more preventive medication prescriptions but reporting less frequent use of these medications is not fully understood but could be explained in part by high preventive medication discontinuation rates 3,27 …”

“…According to national guidelines, preventive migraine medication should be considered in patients who have severe migraine attacks despite acute treatment, frequent attacks, acute medication overuse, adverse effects with acute treatment, or based on patient preference 1 . Additionally, consistent and appropriate use of preventive medication can lessen migraine burden, decrease the risk of headache becoming chronic, and reduce utilization of health‐care resources 2,3 . There are numerous United States Food and Drug Administration (FDA)‐approved preventive medications for migraine treatment in adults; 4 however, the majority of randomized controlled trials that studied the efficacy of preventive medications for pediatric migraine failed to conclusively demonstrate superiority to placebo, and there is only one FDA‐approved preventive medication for children 5,6 .…”

“…1 Additionally, consistent and appropriate use of preventive medication can lessen migraine burden, decrease the risk of headache becoming chronic, and reduce utilization of health-care resources. 2,3 There are numerous United States Food and Drug Administration (FDA)-approved preventive medications for migraine treatment in adults; 4 however, the majority of randomized controlled trials that studied the efficacy of preventive medications for pediatric migraine failed to conclusively demonstrate superiority to placebo, and there is only one FDA-approved preventive medication for children. 5,6 Because of this, lifestyle modifications and non-pharmacological interventions are often emphasized and tried before recommending prescription preventive medications in the pediatric population.…”

Observational Retrospective Study in Patients Treated with Galcanezumab as Preventive Treatment for Migraine: The ORYGAM Study

“…Nevertheless, despite these recommendations constituting a crucial component of migraine management, patients with these characteristics often do not take available preventive migraine treatments. Data have shown that 38% of patients with migraine met the criteria to be offered preventive therapy [ 8 ], and fewer than 25% continue on treatment 1 year after its initiation as a result of inconsistent or suboptimal efficacy and side effects, which results in poor adherence [ 9 ], and an increase in the healthcare resource use and costs [ 10 ].…”