PND29 - a retrospective analysis of the economic burden among patients diagnosed with chronic migraine using the veterans health administration medical data

Abstract

OBJECTIVES: To evaluate the health care resource utilization and costsamong patients diagnosed with chronic migraine (CM) in the Veterans HealthAdministration (VHA) medical dataset. METHODS: Patients diagnosed with CMwere identified (International Classification of Diseases, 9th Revision, ClinicalModification diagnosis code 346.XX) using the VHA dataset from October 1, 2008through September 30, 2010. The initial diagnosis date was designated as the indexdate. Patients without CM with the same age, gender and region (comparison cohort)were matched using a randomly chosen index date to minimize selection bias.Patients in both cohorts were at least age 18 years and had continuous medicaland pharmacy benefits for 1 year before and after the index date. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations between the CM and the comparison cohorts, and was adjusted for baselinedemographic and clinical characteristics. Pain scores were also included to investigate wellness after CM diagnosis. RESULTS: After risk-adjustment by PSM, 123,241patients in each cohort were matched. Significantly more CM patients had inpatientadmissions (6.44% vs. 1.75%, p<0.0001) and emergency room (ER; 14.42% vs. 5.50%,p<0.0001), outpatient office (68.80% vs. 42.15%, p<0.0001), outpatient (69.30% vs.42.91%, p<0.0001) and pharmacy visits (70.84% vs. 41.43%, p<0.0001) compared tothose without CM. Accordingly, CM patients also incurred higher costs for inpatient admissions and ER, office, outpatient and pharmacy visits compared to thosewithout CM. Total costs incurred by CM patients were $4,776, almost triple that of patients without CM ($1,756). There were more CM patients with accompanying painat all levels (mild: 19.53% vs. 0.16%; moderate: 13.10% vs. 0.10%; severe: 16.20% vs.0.12%; all p<0.0001). CONCLUSIONS: CM patients in the VHA population had substantial health care resource utilization, incurred higher costs and suffered worsepain compared to those without the disease.