Economic Impact of Botox in Patients With Chronic Migraine
Objective To determine whether the utilization of healthcare resources is reduced after chronic migraine patients are treated for 6 months with onabotulinumtoxinA.
Background OnabotulinumtoxinA is indicated for headache prophylaxis in patients with chronic migraine, but its effect on healthcare resource use is unknown.
Methods We analyzed data from an open-label study of 230 chronic migraine patients refractory to ≥2 oral prophylactics who presented to a headache specialty clinic and who were treated with two cycles of onabotulinumtoxinA. Frequency and cost of migraine-related healthcare resource use, including visits to emergency departments, urgent care, or hospitalization, were compared for the 6 months before and after initial treatment. Costs were based on publicly available sources.
Results Compared with the 6 months predating initial treatment, patients had 55% fewer emergency department visits (174 vs 385), 59% fewer urgent care visits (61 vs 150), and 57% fewer hospitalizations (19 vs 45) during the 6-month treatment period (P < .01 for all). Analysis of treatment-related costs yielded an average reduction of $1219.33/patient, off-setting 49.7% of the total estimated cost for 6 months of treatment with onabotulinumtoxinA.
Conclusions Although we are unable to distinguish onabotulinumtoxinA's treatment effect from other potential confounding variables, our analysis showed that severely afflicted, treatment-refractory patients with chronic migraine experienced a significant cost-offset through reduced migraine-related emergency department visits, urgent care visits, and hospitalizations in the 6 months following treatment initiation of onabotulinumtoxinA. Future analyses will assess the longer-term effect of onabotulinumtoxinA treatment and the potential contribution of regression to the mean.
Chronic migraine (CM), characterized by ≥15 headache days/month for 3 months, is a disabling condition associated with a high economic and societal burden. It is estimated to impact approximately 1.4–2.2% of the adult population globally and approximately 1% of those in the United States, imparting significant impact on quality of life and disability. Due to increased acute medication use, physician visits, hospitalizations, and emergency department (ED) visits, individuals with CM have been shown to incur significantly higher healthcare costs than individuals with episodic migraine.
Two parallel, large-scale, placebo-controlled trials were conducted to evaluate onabotulinumtoxinA therapy for CM: the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. The PREEMPT trials represent the largest studies in CM to date (n = 1384), and their results indicate that onabotulinumtoxinA treatment is both safe and effective. While the PREEMPT trials clearly established the efficacy of onabotulinumtoxinA in improving both clinical and quality-of-life measures, less clear are the impact of onabotulinumtoxinA on real-world outcomes such as migraine-related healthcare resource use (HRU) and, more specifically, net cost (vs cost-savings) associated with the use of onabotulinumtoxinA to treat CM.
We sought to evaluate migraine-related healthcare resource utilization and direct medical costs prior to and following initiation of treatment with open-label onabotulinumtoxinA for treatment-refractory CM patients.
Abstract and Introduction
Abstract
Objective To determine whether the utilization of healthcare resources is reduced after chronic migraine patients are treated for 6 months with onabotulinumtoxinA.
Background OnabotulinumtoxinA is indicated for headache prophylaxis in patients with chronic migraine, but its effect on healthcare resource use is unknown.
Methods We analyzed data from an open-label study of 230 chronic migraine patients refractory to ≥2 oral prophylactics who presented to a headache specialty clinic and who were treated with two cycles of onabotulinumtoxinA. Frequency and cost of migraine-related healthcare resource use, including visits to emergency departments, urgent care, or hospitalization, were compared for the 6 months before and after initial treatment. Costs were based on publicly available sources.
Results Compared with the 6 months predating initial treatment, patients had 55% fewer emergency department visits (174 vs 385), 59% fewer urgent care visits (61 vs 150), and 57% fewer hospitalizations (19 vs 45) during the 6-month treatment period (P < .01 for all). Analysis of treatment-related costs yielded an average reduction of $1219.33/patient, off-setting 49.7% of the total estimated cost for 6 months of treatment with onabotulinumtoxinA.
Conclusions Although we are unable to distinguish onabotulinumtoxinA's treatment effect from other potential confounding variables, our analysis showed that severely afflicted, treatment-refractory patients with chronic migraine experienced a significant cost-offset through reduced migraine-related emergency department visits, urgent care visits, and hospitalizations in the 6 months following treatment initiation of onabotulinumtoxinA. Future analyses will assess the longer-term effect of onabotulinumtoxinA treatment and the potential contribution of regression to the mean.
Introduction
Chronic migraine (CM), characterized by ≥15 headache days/month for 3 months, is a disabling condition associated with a high economic and societal burden. It is estimated to impact approximately 1.4–2.2% of the adult population globally and approximately 1% of those in the United States, imparting significant impact on quality of life and disability. Due to increased acute medication use, physician visits, hospitalizations, and emergency department (ED) visits, individuals with CM have been shown to incur significantly higher healthcare costs than individuals with episodic migraine.
Two parallel, large-scale, placebo-controlled trials were conducted to evaluate onabotulinumtoxinA therapy for CM: the Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. The PREEMPT trials represent the largest studies in CM to date (n = 1384), and their results indicate that onabotulinumtoxinA treatment is both safe and effective. While the PREEMPT trials clearly established the efficacy of onabotulinumtoxinA in improving both clinical and quality-of-life measures, less clear are the impact of onabotulinumtoxinA on real-world outcomes such as migraine-related healthcare resource use (HRU) and, more specifically, net cost (vs cost-savings) associated with the use of onabotulinumtoxinA to treat CM.
We sought to evaluate migraine-related healthcare resource utilization and direct medical costs prior to and following initiation of treatment with open-label onabotulinumtoxinA for treatment-refractory CM patients.
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