Migraine-specific health resource utilization in chronic and episodic migraine across six countries
Sanderson, Joanna C.
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Background: Though studies have consistently revealed variation in resource utilization between chronic and episodic migraineurs, less is known about how these differences compare across countries. This research describes migraine-specific health resource utilization in chronic and episodic migraineurs across the United States (US), Canada, the United Kingdom (UK), Germany, France and Australia. Methods: A web-based screening survey, used to determine eligibility, was administered to 32,782 panelists who had previously reported experiencing headaches or migraines. Screener respondents (n=16,663) were eligible for the main questionnaire if they were ≥ 18 years of age, reported at least one headache (not associated with a cold, flu, head injury, or hangover) during the prior three months, and reported symptoms meeting the revised second International Classification of Headache Disorders (ICHD-IIR) diagnostic criteria for migraine. For the main questionnaire, respondents provided data concerning sociodemographic and clinical characteristics, attitudes, and utilization of health resources. Results: In bivariate analyses, the intensity of resource use differed across countries in each migraine type. In multivariate regression, the odds of visiting a provider for headache in the three months prior to completing the survey were higher in all countries relative to the US. The odds of having a typical provider of headache care were also higher in all countries relative to the US, but this was only significant for France (OR 1.85, 95% CI 1.04, 3.32). Relative to the US, the odds of having ever visited the emergency room for headache were significantly lower in France (OR 0.37, 95% CI 0.22, 0.62), the UK (OR 0.25, 95% CI 0.14, 0.45) and Germany (OR 0.31, 95% CI 0.18, 0.53). Respondents from Australia (OR 1.83, 95% CI 1.13, 2.96) and France (OR 1.51, 95% CI 1.00, 2.28) were more likely than those from the US to report ever trying more than three abortive agents. The odds of currently using a prescription abortive agent were significantly higher in France (OR 1.80, 95% CI 1.19, 2.74), the UK (OR 2.68, 95% CI 1.72, 4.17), Australia (OR 1.88, 95% CI 1.16, 3.03) and Germany (OR 2.10, 95% CI 1.37, 3.23) than in the US. Conclusion: Migraineurs differed significantly across countries in their demographic and clinical characteristics, and in the resources they utilized. Migraineurs from the US were generally less likely to report use of preventative services, such as recent provider visits and use of prescription abortive agents, and more likely to report emergency room visits, relative to migraineurs from the other countries studied. However, US migraineurs were also less likely to report ever being hospitalized for headache compared to migraineurs from Canada and Australia. Further research on the sources of this variability, including the influence of healthcare system design features, and the effects of the variability on outcomes in migraineurs is warranted.
- Pharmaceutics