Total health insurance costs in children with a migraine diagnosis compared to a control group

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Abstract

Background

Health care costs of migraine constitute a major issue in health economics. Several publications analyzed health care costs for adult migraine patients, based on questionnaires or secondary (health insurance) data. Although migraine often starts already in primary school age, data on migraine related costs in children is scarce. In this paper we aimed to assess the migraine-related health care costs in 6 to 11 year old children in Germany.

Methods

Using claims data of a large German health insurer (BARMER), overall annual health care costs of 6 to 11 year old children with a diagnosis of migraine in 2017 ( n = 2597) were compared to a control group of 6 to 11 year old children without a headache diagnosis between 2013 and 2017 ( n = 306,926). The association of migraine and costs was modeled by generalized linear regression (Gamma regression) with adjustment for sex, age and comorbidities.

Results

Children with migraine caused considerably higher annual per capita health care costs than children without a headache diagnosis (migraine group: € 1018, control group: € 618). Excess costs directly related to migraine amounted to € 115. The remaining excess costs were related to comorbidities, which were more frequent in the migraine group. Mental and behavioural disorders constituted the most expensive comorbidity, accounting for € 105 of the € 400 annual excess costs in the migraine group.

Conclusion

6 to 11 year old children with a migraine diagnosis cause significant direct and comorbidity related excess costs in the German health care system.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01349-w.

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Most cited references 20

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The cost of headache disorders in Europe: the Eurolight project.

M Linde, A. Gustavsson, L J Stovner … (2012)

Headache disorders are very common, but their monetary costs in Europe are unknown. We performed the first comprehensive estimation of how economic resources are lost to headache in Europe. From November 2008 to August 2009, a cross-sectional survey was conducted in eight countries representing 55% of the adult EU population. Participation rates varied between 11% and 59%. In total, 8412 questionnaires contributed to this analysis. Using bottom-up methodology, we estimated direct (medications, outpatient health care, hospitalization and investigations) and indirect (work absenteeism and reduced productivity at work) annual per-person costs. Prevalence data, simultaneously collected and, for migraine, also derived from a systematic review, were used to impute national costs. Mean per-person annual costs were €1222 for migraine (95% CI 1055-1389; indirect costs 93%), €303 for tension-type headache (TTH, 95% CI 230-376; indirect costs 92%), €3561 for medication-overuse headache (MOH, 95% CI 2487-4635; indirect costs 92%), and €253 for other headaches (95% CI 99-407; indirect costs 82%). In the EU, the total annual cost of headache amongst adults aged 18-65 years was calculated, according to our prevalence estimates, at €173 billion, apportioned to migraine (€111 billion; 64%), TTH (€21 billion; 12%), MOH (€37 billion; 21%) and other headaches (€3 billion; 2%). Using the 15% systematic review prevalence of migraine, calculated costs were somewhat lower (migraine €50 billion, all headache €112 billion annually). Headache disorders are prominent health-related drivers of immense economic losses for the EU. This has immediate implications for healthcare policy. Health care for headache can be both improved and cost saving. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

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Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS)

L. M. Bloudek, M. Stokes, D. C. Buse … (2012)

Migraine is a disabling neurological disease that affects 14.7 % of Europeans. Studies evaluating the economic impact of migraine are complex to conduct adequately and with time become outdated as healthcare systems evolve. This study sought to quantify and compare direct medical costs of chronic migraine (CM) and episodic migraine (EM) in five European countries. Cross-sectional data collected via a web-based survey were screened for migraine and classified as CM (≥15 headache days/month) or EM (<15 headache days/month), and included sociodemographics, resource use data and medication use. Unit cost data, gathered using publicly available sources, were analyzed for each type of service, stratified by migraine status. Univariate and multivariate log-normal regression models were used to examine the relationship between various factors and their impact on total healthcare costs. This economic analysis included data from respondents with migraine in the UK, France, Germany, Italy, and Spain. CM participants had higher level of disability and more prevalent psychiatric disorders compared to EM. CM participants had more provider visits, emergency department/hospital visits, and diagnostic tests; the medical costs were three times higher for CM than EM. Per patient annual costs were highest in the UK and Spain and lower in France and Germany. CM was associated with higher medical resource use and total costs compared to EM in all study countries, suggesting that treatments that reduce headache frequency could decrease the clinical and economic burden of migraine in Europe. Comparing patterns of care and outcomes among countries may facilitate the development of more cost-effective care, and bring greater recognition to patients affected by migraine.

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[Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor].

Karl Hoffmann, A Icks (2012)

Claims data of health insurance companies are an important database for health services research. We investigated if there are differences in baseline characteristics and prevalence of chronic diseases between members of several health insurance funds in Germany, and if so, whether adjusting for age and sex could explain these differences. 10 representative surveys (conducted between 2004 and 2008) of the 'Bertelsmann Health-Care Monitor' comprising 15 089 participants aged 18 to 79 years were analysed. Our main independent variable was membership in one of 8 health insurance funds. The prevalence of self-reported hypertension, diabetes, atopic diseases, coronary heart disease and heart failure was studied. We first estimated the crude prevalence of chronic diseases stratified by these funds. We further fitted logistic regression models and adjusted for age and sex as well as for further comorbidities and health related factors. Most respondents were insured in the BKK (Betriebskrankenkassen; 20.1%), the AOK (Allgemeinen Ortskrankenkassen; 19.2%) and private health insurances (15.3%). Substantial differences were found according to age, sex, educational level and prevalences of chronic diseases. Stratified by health insurance funds, prevalences ranged between 17.1-29.6% for hypertension, between 3.9-11.4% for diabetes, between 4.3-6.7% for atopic diseases, between 3.4-6.7% for coronary heart disease and between 2.6-5.7% for heart failure. When adjusting for sex and age, estimates for all 5 diseases were significant higher in AOK members compared to privately insured persons (3 diseases within the BAMER and the DAK, accordingly). In total, this was the case for 17 out of 35 comparisons. Even after adjusting for further comorbidities and health related factors 6 out of 35 comparisons showed significant increased estimates compared to privately insured persons. We found considerable differences in the prevalence of chronic diseases between German health insurance funds that remained after controlling for age and sex, and even after adjustment for further health-related variables. Further methodological studies are urgently needed to assess strengths and weaknesses of German claim data. © Georg Thieme Verlag KG Stuttgart · New York.

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Author and article information

Contributors

Ruth Ruscheweyh:

ORCID: http://orcid.org/0000-0001-9510-7158

ruth.ruscheweyh@med.uni-muenchen.de

Journal

Journal ID (nlm-ta): J Headache Pain

Journal ID (iso-abbrev): J Headache Pain

Title: The Journal of Headache and Pain

Publisher: Springer Milan (Milan )

ISSN (Print): 1129-2369

ISSN (Electronic): 1129-2377

Publication date (Electronic): 20 November 2021

Publication date PMC-release: 20 November 2021

Publication date Collection: 2021

Volume: 22

Issue: 1

Electronic Location Identifier: 140

Affiliations

[1 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, Ludwig Maximilians University Munich, Institute for Social Pediatrics and Adolescent Medicine, ; Munich, Germany

[2 ]GRID grid.417840.e, ISNI 0000 0001 1017 4547, IFT Institut für Therapieforschung, ; Munich, Germany

[3 ]GRID grid.4567.0, ISNI 0000 0004 0483 2525, Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), ; Neuherberg, Germany

[4 ]GRID grid.411095.8, ISNI 0000 0004 0477 2585, Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, , Ludwig Maximilians University Hospital Munich, ; Munich, Germany

[5 ]GRID grid.411095.8, ISNI 0000 0004 0477 2585, Department of Neurology, , Ludwig Maximilians University Hospital Munich, ; Munich, Germany

Author information

Ruth Ruscheweyh http://orcid.org/0000-0001-9510-7158

Article

Publisher ID: 1349

DOI: 10.1186/s10194-021-01349-w

PMC ID: 8605561

PubMed ID: 34800970

SO-VID: 3bad82bb-62c9-48f5-ad9a-1c3ac67617e9

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 2 September 2021

Date accepted : 28 October 2021

Funding

Funded by: The Federal Joint Committee, Innovation Committee (G-BA, Innovationsfonds),

Award ID: 01NVF17044

Funded by: Universitätsklinik München (6933)

Custom metadata

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: health care costs,migraine,headache,children,claims data

Data availability:

ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: health care costs, migraine, headache, children, claims data

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Total health insurance costs in children with a migraine diagnosis compared to a control group

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Abstract

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Supplementary Information

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Cardiovascular Innovations and Applications

Most cited references 20

The cost of headache disorders in Europe: the Eurolight project.

Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS)

[Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor].

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Cited by 4

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