Devine, BethCai, Kimberly2021-10-292021-10-292021Cai_washington_0250O_23519.pdfhttp://hdl.handle.net/1773/47900Thesis (Master's)--University of Washington, 2021BACKGROUND: Migraines are a debilitating neurological condition highly prevalent worldwide. Migraines can be characterized as chronic or episodic, depending on frequency and intensity. Chronic migraines are defined by the International Headache Society as ≥15 headache days per month (HDM) for at least 3 months with at least 8 days per month of migraine-specific headaches or treatment with a migraine-specific medication (i.e., triptans). Episodic migraines are defined as <15 headache days per month. Previous studies have examined chronic migraine patients compared to episodic migraine patients, or migraine patients as a whole compared to non-migraine controls. This study serves to compare each subgroup to non-migraine controls within a mixed commercial and Medicare supplemental population for the 2016-2018 study period. OBJECTIVE: To assess the annual healthcare resource use and costs between chronic migraine patients and non-migraine controls, and episodic migraine patients and non-migraine controls. METHODS: We conducted a retrospective cohort analysis using health insurance claims data from the IBM Watson Health MarketScan Commercial and Medicare Supplemental database® using data from January 1, 2016 through December 31, 2018. The populations of interest were adults ≥18 years with chronic or episodic migraine defined from migraine-associated claims within the 2017 index year. We then compared chronic and episodic migraine cohorts were to a 36-month continuously enrolled non-migraine cohort. We used multivariable linear regression comparing the incidence of healthcare resource use [inpatient admissions, emergency department (ED) visits, neurologist visits, outpatient services (excluding ED and neurologist visits), and pharmacy services] and costs based on migraine or non-migraine designations were performed and adjusted for covariates and clinical characteristics. Costs were reported in 2018 U.S. dollars. RESULTS: The analysis compared a chronic migraine cohort (n = 30,004) to a randomly selected 5% non-migraine cohort (n = 343,095), and an episodic migraine cohort (n = 77,835) to the same 5% non-migraine cohort. Cohorts were not matched, but demographic and clinical characteristics were adjusted for in the multivariable regression. Across all outcomes of interest, chronic and episodic migraine patients used more healthcare resources and incurred higher costs when compared to their non-migraine counterparts. Of note, chronic migraine patients used 60 (95% CI: [56, 65]) more all-cause outpatient services and averaged $9,958 (95% CI: [$8,437, $10,893]) higher costs for these outpatient services compared to non-migraine controls. Similarly, but to a lesser degree, episodic migraine patients used 41 (95% CI: [40, 43]) more all-cause outpatient services and $6,132 ([95% CI: $5,413, $6,945]) higher costs compared to non-migraine controls. CONCLUSION: Our results suggest that chronic and episodic migraine patients have both higher healthcare resource use and higher costs across inpatient admissions, ED visits, neurologist visits, outpatient services, and overall pharmaceutical claims. These results quantify one aspect of the economic burden of migraine compared to a non-migraine, commercially insured population; and to more thoroughly inform direct healthcare resource use and costs that a migraine patient may accrue.application/pdfen-USCC BY-SAcosthealth economicshealthcare resource utilizationHEORmarketscanmigraineHealth sciencesPharmaceutical sciencesThesis