Healthcare utilization, expenditure, and medication use in commercially insured patients with migraine

Migraine is characterized by recurrent moderate to severe pain on one side of the head. One-seventh of Americans suffer from migraines. Migraines are associated with high levels of productivity loss and health resource use, with corresponding decreased quality of life. The aims of this study were to compare healthcare utilization and costs for patients with chronic migraine (CM), episodic migraine (EM), and tension-type headache (TTH); evaluate adherence and persistence to preventive medications among CM patients; and assess opioid use and explore risk factors of migraine progression. This was a retrospective analysis of Optum Clinformatics® Data Mart medical and pharmacy claims database from 2015-2018. Adults with continuous enrollment and diagnoses of migraine were identified. Generalized linear models assessed healthcare utilization and costs. Medication adherence was evaluated using proportion of days covered (PDC). Opioid use was measured by average daily morphine milligram equivalents (MMEs). Cox proportional hazard models assessed risk factors of new onset CM. Criteria were met for 45,849 patients (8,955 CM; 31,961 EM; 4,933 TTH). Annual all-cause direct medical costs were CM $17,878; EM $12,986; and TTH $7,902. Annual migraine/TTH-related costs were CM $1,869; EM $446; and TTH $157. All cost comparisons were statistically significantly different. At 12 months, 40% of the CM patients were adherent to their oral preventive medications (OPMs), and 32% of patients were persistent without a 30-day gap. The average time to discontinuation was 6.9 months. Overall, 35% of migraine patients received prescription opioids during follow-up. A significant association was found between MME level and risk of new onset CM. Additional risk factors of migraine progression included younger age, female sex, South and West regions, and having a diagnosis of medication overuse headache, depression, back pain, or fibromyalgia (all P