Risk–benefit and cost–benefit ratio in headache treatment

Abstract

IntroductionHeadache disorders are ubiquitous, common, disabling and to a very large extent treatable in primary care. Migraine headaches affect 12% of the adult population worldwide and cause significant economic loss due to decreased workplace productivity. Although interactions between pharmacists and individuals with headache are common, few pharmacists receive adequate training regarding migraine therapy. There are several misconceptions that hinder effective care, such as that migraine is a vascular disease, triptans cause rampant cardiac-related morbidity and even mortality. The last decade's experience with triptans in more than half a billion people worldwide reveals a benign adverse-effect profile, particularly when taken early in an attack. Published reports and real-world experiences illustrate that these drugs do not merit fears of triptan-induced cardiac consequences in appropriately selected individuals. Society's productivity loss due to migraine is measured in billions of dollars. Restoring a patient's ability to function normally is now recognised as the primary treatment goal, not merely relieving pain. Thus, the over-reliance on "pain killer" drugs such as butalbital-containing products and the continued underutilisation of migraine-specific drugs need to be addressed [1]. Attack treatmentOne of the main problems in treating migraine is how to treat attacks. In this situation it has been shown that stratified care is more efficacious and economic than step care strategies [2]. These results were confirmed later and a J Headache Pain (2005) 6:315-318 DOI 10.1007/s10194-005-0219-5 Abstract The cost-benefit and the risk-benefit ratios are two of the most relevant items in ongoing health organisation procedures. The choice of a new or an old therapeutic treatment depends on a number of factors and the evaluation of the cost, in terms of economics, but also in terms of quality of life and type of facilities necessary for one treatment are crucial criteria. Therefore, we have to consider in evaluating treatment strategies not only the activity of a drug in reaching the main endpoints, (i.e., pain free or headache relief) but also the safety and perception of safety by patients, and the cost effectiveness, including indirect costs compared with personal and social benefits. Because it is reasonable that a subgroup of migraine patients may have a clinically progressive disorder, studies should be necessary to assess strategies for migraine treatments. Risk-benefit and cost-benefit ratio in headache treatment H E A D A C H E : T H E R A P E U T I C C H

The associations of migraines and other headaches with work performance: Results from the National Comorbidity Survey Replication (NCS-R)

“…It is not clear if a positive employer return-on-investment (ROI) would be found in such experiments, but the estimated average annual $1,165 human capital cost associated with frequent or severe migraines obtained in the NCS-R is high enough to think that even partial remediation might have a positive ROI, especially given that this estimate of human capital cost might be downwardly biased by virtue of the coarseness of our measure of work performance. More complex intervention targeting approaches, possibly aimed at interfering with illness progression (63) or at tailoring treatments based on comorbidities (64) or at providing coordinated management as well as treatment (65), might show even higher long-term ROIs. Documentation of such positive effects could be of great value in promoting the expansion of workplace migraine screening and disease management programs to address the low detection and treatment of workers with migraines (8, 9).…”

Impact of Individual Headache Types on the Work and Work Efficiency of Headache Sufferers

“…The impact of headache disorders is a problem of enormous proportions, both for individuals and society [23,24]. The cost-benefit and risk-benefit ratios are two of the most relevant items in ongoing health-organization procedures [25]. Physicians frequently find themselves in situations where they have to consider the economic aspects of a treatment even though they have not been trained for it.…”

“…Numerous studies demonstrated that headaches adversely affect various aspects of the sufferer's life [25][26][27][28][29][30]. Trying to understand how a headache influenced work efficiency in our subjects, we asked them how a headache affects their work by offering several answers and allowing them to specify some other effects of their headaches.…”

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

“…Such a traditional cost–benefit analysis would involve the very difficult task of translating outcomes of all considered modalities into a similar metric, and in equating the groups of patients who may have been selected to receive a particular treatment based on a pre‐existing need (eg, a depressive disorder, personality disorder, etc). Because the cost minimization analysis assumes equivalent outcomes, and in turn equivalence across patient samples, subsequent studies should attend to issues of patient selection and equivalence regarding factors such as headache frequency, rates of medication overuse, and comorbid disorders, Similar cost–benefit analyses could focus more broadly on comparisons of associated facility costs, patient perceptions of treatment safety, and outcomes that extend beyond symptom reduction (ie, quality of life, improved functioning) 28 …”

“…Because the cost minimization analysis assumes equivalent outcomes, and in turn equivalence across patient samples, subsequent studies should attend to issues of patient selection and equivalence regarding factors such as headache frequency, rates of medication overuse, and comorbid disorders, Similar cost-benefit analyses could focus more broadly on comparisons of associated facility costs, patient perceptions of treatment safety, and outcomes that extend beyond symptom reduction (ie, quality of life, improved functioning). 28 Conversely, the combination of pharmacotherapy and behavioral interventions can be more effective than either alone, 15 but at the present time it is unclear if the combined approach is associated with cost savings. It is conceivable that the selfmanagement strategies encouraged by the behavioral approaches might lead to reduced medical costs in the long term.…”