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 av...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | The Journal of Headache and Pain |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s10194-022-01448-2 |
| _version_ | 1811219248686563328 |
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| author | Pablo Irimia David García-Azorín Mercedes Núñez Sílvia Díaz-Cerezo Pepa García de Polavieja Tommaso Panni Aram Sicras-Navarro Antoni Sicras-Mainar Antonio Ciudad |
| author_facet | Pablo Irimia David García-Azorín Mercedes Núñez Sílvia Díaz-Cerezo Pepa García de Polavieja Tommaso Panni Aram Sicras-Navarro Antoni Sicras-Mainar Antonio Ciudad |
| author_sort | Pablo Irimia |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T07:23:02Z |
| format | Article |
| id | doaj.art-b9421597993549eda39f43ba8bc5b0d4 |
| institution | Directory Open Access Journal |
| issn | 1129-2369 1129-2377 |
| language | English |
| last_indexed | 2024-04-12T07:23:02Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | The Journal of Headache and Pain |
| spelling | doaj.art-b9421597993549eda39f43ba8bc5b0d42022-12-22T03:42:16ZengBMCThe Journal of Headache and Pain1129-23691129-23772022-07-0123111510.1186/s10194-022-01448-2Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC studyPablo Irimia0David García-Azorín1Mercedes Núñez2Sílvia Díaz-Cerezo3Pepa García de Polavieja4Tommaso Panni5Aram Sicras-Navarro6Antoni Sicras-Mainar7Antonio Ciudad8Department of Neurology, Headache Unit, University Clinic of NavarraHeadache Unit, Department of Neurology, Hospital Clínico Universitario de ValladolidLilly SpainLilly SpainLilly SpainLilly Deutschland GmbHAtrys Health, HEORAtrys Health, HEORLilly SpainAbstract 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.https://doi.org/10.1186/s10194-022-01448-2Migraine disordersHealthcare costsHealth resourcesTherapeuticsPain managementPrevention and control |
| spellingShingle | Pablo Irimia David García-Azorín Mercedes Núñez Sílvia Díaz-Cerezo Pepa García de Polavieja Tommaso Panni Aram Sicras-Navarro Antoni Sicras-Mainar Antonio Ciudad Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study The Journal of Headache and Pain Migraine disorders Healthcare costs Health resources Therapeutics Pain management Prevention and control |
| title | Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study |
| title_full | Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study |
| title_fullStr | Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study |
| title_full_unstemmed | Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study |
| title_short | Persistence, use of resources and costs in patients under migraine preventive treatment: the PERSEC study |
| title_sort | persistence use of resources and costs in patients under migraine preventive treatment the persec study |
| topic | Migraine disorders Healthcare costs Health resources Therapeutics Pain management Prevention and control |
| url | https://doi.org/10.1186/s10194-022-01448-2 |
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