Daily migraine prevention and its influence on resource utilization in the military health system
Migraine is a widespread and disabling neurological disorder with a substantial economic burden due to the frequency and severity of the disease. Daily migraine prevention is recommended for patients who experience regular migraine headaches. While the safety and efficacy of this treatment has been established, it is unclear what impact migraine prevention has on health care resource consumption. This study was undertaken to determine if the initiation of daily migraine prevention had an effect on ambulatory health care utilization compared to acute migraine treatment alone.
Administrative claims data from the Military Health System were used to conduct a retrospective, longitudinal cohort study of 8,436 beneficiaries who received both a diagnosis of headache and a prescription for a migraine-specific abortive medication over a two year time period from 1 October 2002 to 30 September 2004. Patients were categorized by exposure status to daily migraine prevention. New users (N = 1,144) were compared to subjects receiving acute headache treatment alone (N = 2,618) during 18 months of follow-up. A series of regression and matching estimators modeled the effect of prevention on ambulatory health care utilization while controlling for patient characteristics selected from Andersen's Behavioral Model of Health Care Utilization.
The study results showed that exposure to daily migraine prevention influenced ambulatory health care utilization in the Military Health System. Treatment with prevention resulted in lower rates of utilization relative to what new users of prevention would have consumed in the absence of treatment. Reductions in post-treatment spending observed among new users were primarily driven by declines in the use of non-emergent care services.
The results suggest that additional economic benefits could be realized by increasing the appropriate use of daily migraine prevention. Health care providers must play an important part in reaching this goal by targeting those individuals most likely to derive a benefit from treatment. Health policies that successfully identify untreated candidates for daily migraine prevention and encourage open discussions between providers and patients about individual patient preferences as well as the benefits and risks of prevention should be considered.
Health services utilization;
0769: Health care