Healthcare Resource Utilization and Costs Associated with Misdiagnosis of Migraine

Abstract

BACKGROUND: Migraine is commonly misdiagnosed and undertreated and can be confused with other conditions that also cause facial pain or headache. The most common misdiagnoses for migraine are headache, sinusitis, and cervical pain. It is possible that misdiagnosis may lead to inappropriate and ineffective treatment, unnecessary consultations, and unnecessary diagnostic evaluations for patients, culminating in untreated migraine and an economic burden for patients. This study evaluated healthcare resource utilization (HRCU) and costs among migraine patients with a prior misdiagnosis of migraine versus migraine patients without a prior misdiagnosis.OBJECTIVE: To assess the impact of a migraine misdiagnosis on all-cause health care resource utilization and all-cause direct healthcare costs in migraine patients. METHODS: A retrospective claims analysis was conducted using data from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases. Adults with a migraine diagnosis were identified from June 2018 to June 2019, and further classified into a misdiagnosis cohort or correct diagnosis cohort based on whether or not they had a prior potential misdiagnosis (PM). PM was defined as a prior diagnosis of headache, sinusitis, or cervical pain within 2 years prior to the migraine diagnosis date. HCRU and direct healthcare costs were compared between the two groups, as well as between a subgroup of multiple misdiagnosis and the correct diagnosis group. Outcomes were reported as incidence rate ratios (IRR), adjusted for age, gender, region, plan type, and comorbidities. RESULTS: In all, 3,841 migraine patients with a prior PM, and 29,147 migraine patients without a prior PM met the inclusion criteria. Patients with PM had a significantly higher rate of inpatient admissions, emergency department (ED) visits, neurologist visits, outpatient visits, and prescription fills per month (IRR: 1.61, 1.92, 5.92, 1.67, and 1.52, respectively, all p<0.001) compared to patients without PM. Patients in the misdiagnosed cohort also had a significantly higher rate of healthcare cost accrual for inpatient admissions, ED visits, neurologist visits, outpatient visits, and prescription fills per month (IRR: 3.22, 2.66, 2.28, 2.06, and 1.36, respectively, all p<0.001) compared to patients without PM. CONCLUSION: Our study suggests that migraine patients with a prior PM have significantly higher rates of HCRU, and cost accrual compared to migraine patients without a prior PM. Our results suggest that an incorrect incident migraine diagnosis significantly increases HCRU and costs for migraine patients.