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

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          Abstract

          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 Studies evaluating the economic impact of migraine are complex to conduct adequately and with time become outdated as healthcare systems evolve.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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          Most cited references26

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

          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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            Global prevalence of chronic migraine: a systematic review.

            The aim of this review was to summarize population-based studies reporting prevalence and/or incidence of chronic migraine (CM) and to explore variation across studies. A systematic literature search was conducted. Relevant data were abstracted and estimates were subdivided based on the criteria used in each study. Sixteen publications representing 12 studies were accepted. None presented data on CM incidence. The prevalence of CM was 0-5.1%, with estimates typically in the range of 1.4-2.2%. Seven studies used Silberstein-Lipton criteria (or equivalent), with prevalence ranging from 0.9% to 5.1%. Three estimates used migraine that occurred ≥15 days per month, with prevalence ranging from 0 to 0.7%. Prevalence varied by World Health Organization region and gender. This review identified population-based studies of CM prevalence, although heterogeneity across studies and lack of data from certain regions leaves an incomplete picture. Future studies on CM would benefit from an International Classification of Headache Disorders consensus diagnosis that is clinically appropriate and operational in epidemiological studies.
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              Prevalence and burden of migraine in the United States: data from the American Migraine Study II.

              To describe the prevalence, sociodemographic profile, and the burden of migraine in the United States in 1999 and to compare results with the original American Migraine Study, a 1989 population-based study employing identical methods. A validated, self-administered questionnaire was mailed to a sample of 20 000 households in the United States. Each household member with severe headache was asked to respond to questions about symptoms, frequency, and severity of headaches and about headache-related disability. Diagnostic criteria for migraine were based on those of the International Headache Society. This report is restricted to individuals 12 years and older. Of the 43 527 age-eligible individuals, 29 727 responded to the questionnaire for a 68.3% response rate. The prevalence of migraine was 18.2% among females and 6.5% among males. Approximately 23% of households contained at least one member suffering from migraine. Migraine prevalence was higher in whites than in blacks and was inversely related to household income. Prevalence increased from aged 12 years to about aged 40 years and declined thereafter in both sexes. Fifty-three percent of respondents reported that their severe headaches caused substantial impairment in activities or required bed rest. Approximately 31% missed at least 1 day of work or school in the previous 3 months because of migraine; 51% reported that work or school productivity was reduced by at least 50%. Two methodologically identical national surveys in the United States conducted 10 years apart show that the prevalence and distribution of migraine have remained stable over the last decade. Migraine-associated disability remains substantial and pervasive. The number of migraineurs has increased from 23.6 million in 1989 to 27.9 million in 1999 commensurate with the growth of the population. Migraine is an important target for public health interventions because it is highly prevalent and disabling.
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                Author and article information

                Contributors
                +1-714-2465438 , Bloudek_Lisa@Allergan.com
                Journal
                J Headache Pain
                J Headache Pain
                The Journal of Headache and Pain
                Springer Milan (Milan )
                1129-2369
                1129-2377
                29 May 2012
                29 May 2012
                July 2012
                : 13
                : 5
                : 361-378
                Affiliations
                [1 ]Allergan Inc., 2525 Dupont Drive, Irvine, CA 92612 USA
                [2 ]United BioSource Corporation, Bethesda, MD USA
                [3 ]Montefiore Headache Center and the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY USA
                [4 ]The Neurology Center, Encinitas, CA USA
                [5 ]Headache Group, Department of Neurology, University of California, San Francisco, San Francisco, CA USA
                [6 ]Department of Neurology, University of Essen, Essen, Germany
                [7 ]Area of Clinical Neuroscience, Service of Neurology, University Hospital ‘‘Central de Asturias’’, Oviedo, Spain
                [8 ]Département d’Evaluation et traitement de la Douleur Médecine palliative, Pôle Neurosciences Cliniques du CHU de Nice, Hôpital Cimiez, Nice Cedex, France
                [9 ]IRCCS Institute of Neurological Sciences, Bologna, Italy
                [10 ]Department of Neurological Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
                [11 ]Department of Clinical and Molecular Medicine, Sapienza University of Rome, Regional Referral Headache Centre, Sant’Andrea Hospital, Rome, Italy
                Article
                460
                10.1007/s10194-012-0460-7
                3381065
                22644214
                ba760358-f87e-470e-b1fd-97f9031df896
                © The Author(s) 2012
                History
                : 11 April 2012
                : 7 May 2012
                Categories
                Original
                Custom metadata
                © Springer-Verlag 2012

                Anesthesiology & Pain management
                spain,italy,resource utilization,chronic migraine,germany,united kingdom,france,cost,migraine,episodic migraine

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