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Migraine Prophylaxis in Managed Care Organizations

Unclear Role in Disease Management Programs

  • Review Article
  • Published:
Disease Management & Health Outcomes

Abstract

Migraine is a highly prevalent, chronic, episodic condition. The direct and indirect costs of migraine have a large economic impact. Research has shown that migraine abortive medications reduce healthcare costs, improve health-related quality of life, decrease migraine disability and keep patients effective in the workplace. This class of medications, therefore, has a clearly defined role within a disease management program. However, the role of prophylactic medications in terms of costs and patient-focused outcomes within a disease management program has not been clearly defined.

Based on a review of the US Headache Consortium Evidence-Based Treatment Guidelines and an examination of issues surrounding prophylactic medications, we conclude that the role of preventive therapy in terms of costs and patient-focused outcomes is not clearly defined. Currently, there are insufficient data available to assess the impact of migraine prophylactic therapy on costs and patient-focused outcomes. Hence, it is premature to state the precise role of preventive therapy in a migraine disease management program. Additional research is needed to better delineate the criteria for migraine prophylaxis, to validate clinical efficacy studies of preventive therapy, to determine the cost-effectiveness of prophylactic therapy, and to determine the effect of preventive therapy on patients’ health resource use, health-related quality of life, and lost productivity.

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References

  1. International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988; 8: 1–96.

    Article  Google Scholar 

  2. Stewart WF, Shechter A, Rasmussen BK. Migraine prevalence: a review of population-based studies. Neurology 1994; 44: S17–23.

    PubMed  CAS  Google Scholar 

  3. Solomon GD. Interventions and outcomes management in migraine. Dis Manag Health Outcomes 1998; 3: 183–90.

    Article  Google Scholar 

  4. Ramadan NM, Silberstein SD, Freitag FG, et al. Evidence-based guidelines for migraine headache in the primary care setting: pharmacological management for prevention of migraine. AAN headache guidelines: multispecialty consensus on diagnosis and treatment of headache. St Paul (MN): American Academy of Neurology, 2000. Available from URL: http://w.aan.com/public/practiceguidelines/headache_gl.htm.

  5. Silberstein SD, Young WB. Headahce and facial pain. In: Goetz CG, Pappert EJ, editors. Textbook of clinical neurology. 1st ed. Philadelphia (PA): WB Saunders, 1999: 1089–95.

    Google Scholar 

  6. Linet MS, Stewart WF, Celentano DD, et al. An epidemiologic study of headache among adolescents and young adults. JAMA 1989; 261: 2211–6.

    Article  PubMed  CAS  Google Scholar 

  7. Lipton RB, Stewart WF. Migraine in the United States: a review of epidemiology and health care use. Neurology 1993; 43: S6–10.

    PubMed  CAS  Google Scholar 

  8. Stewart WF, Lipton RB, Celentano DD. Prevalence of migraine headache in the United States. JAMA 1992; 267: 64–9.

    Article  PubMed  CAS  Google Scholar 

  9. Slang PE, Osterhaus JT. Impact of migraine in the United States: data from the national health interview survey. Headache 1993; 33: 29–35.

    Article  Google Scholar 

  10. Hu XH, Markson LE, Lipton RB, et al. Burden of migraine in the United States: disability and economic costs. Arch Intern Med 1999; 159: 813–8.

    Article  PubMed  CAS  Google Scholar 

  11. Osterhaus JT, Gutterman DL, Plachetka JR. Healthcare resource and low labour costs of migraine headaches in the US. Pharmacoeconomics 1992; 2: 2–11.

    Article  Google Scholar 

  12. van Roijen L, Essink-Bot ML, Koopmanschap MA, et al. Societal perspective on the burden of migraine in The Netherlands. Pharmacoeconomics 1995; 7: 170–9.

    Article  PubMed  Google Scholar 

  13. Solomon G. Interventions and outcomes management in migraine. Dis Manag Health Outcomes 1998; 3: 183–90.

    Article  Google Scholar 

  14. Schulman EA, Cady RK, Henry D, et al. Effectiveness of sumatriptan in reducing productivity loss due to migraine: results of a randomized, double-blind, placebo-controlled clinical trial. Mayo Clin Proc 2000; 75: 782–9.

    Article  PubMed  CAS  Google Scholar 

  15. Mushet GR, Miller D, Clements B, et al. Impact of sumatriptan on workplace productivity, nonwork activities, and health-related quality of life among hospital employees with migraine. Headache 1996; 36: 137–43.

    Article  PubMed  CAS  Google Scholar 

  16. Cohen JA, Beall D, Beck A, et al. Sumatriptan treatment for migraine in a health maintenance organization: economic, humanistic, and clinical outcomes. Clin Ther 1999; 21: 190–205.

    Article  PubMed  CAS  Google Scholar 

  17. Adelman JU, Sharfman M, Johnson R, et al. Impact of oral sumatriptan on workplace productivity, health-related quality of life, healthcare use, and patient satisfaction with medication in nurses with migraine. Am J Manag Care 1996; 2: 1407–16.

    Google Scholar 

  18. Solomon GD, Skobieranda FG, Genzen JR. Quality of life assessment among migraine patients treated with sumatriptan. Headache 1995; 35: 449–54.

    Article  PubMed  CAS  Google Scholar 

  19. Cortelli P, Dahlof C, Bouchard J, et al. A multinational investigation of the impact of subcutaneous sumatriptan III: workplace productivity and non-workplace activity. Pharmacoeconomics 1997; 11: 35–42.

    Article  PubMed  Google Scholar 

  20. Cady RC, Ryan R, Jhingran P, et al. Sumatriptan injection reduces productivity loss during a migraine attack. Arch Intern Med 1998; 158: 1013–8.

    Article  PubMed  CAS  Google Scholar 

  21. Litaker DG, Solomon GD, Genzen JR. Impact of sumatriptan on clinic utilization and costs of care in migraineurs. Headache 1996; 36: 538–41.

    Article  PubMed  CAS  Google Scholar 

  22. Greiner DL, Addy SN. Sumatriptan use in a large group-model health maintenance organization. Am J Health Syst Pharm 1996; 53: 633–8.

    PubMed  CAS  Google Scholar 

  23. Ramadan NM, Schultz LL, Gilkey SJ. Migraine prophylactic drugs: proof of efficacy, utilization and cost. Cephalalgia 1997; 17: 73–80.

    Article  PubMed  CAS  Google Scholar 

  24. Stewart WF, Lipton RB, Celentano DD. Prevalence of migraine headache in the United States. JAMA 1992; 267: 64–9.

    Article  PubMed  CAS  Google Scholar 

  25. Celentano DD, Stewart WF, Lipton RB, et al. Medication use and disability among migraineurs: a national probability sample survey. Headache 1992; 32: 223–8.

    Article  PubMed  CAS  Google Scholar 

  26. Packard RC, O’Connell P. Medication compliance among headache patients. Headache 1986; 26: 416–9.

    Article  Google Scholar 

  27. Stang PE, Osterhaus JT. Impact of migraine in the United States: data from the national health interview survey. Headache 1993; 33: 29–35.

    Article  PubMed  CAS  Google Scholar 

  28. Stang PE, Osterhaus JT, Celentano DD. Migraine: patterns of healthcare use. Neurology 1994; 44: S47–55.

    Article  PubMed  CAS  Google Scholar 

  29. Smith R. Impact of migraine on the family. Headache 1998; 38: 423–6.

    Article  PubMed  CAS  Google Scholar 

  30. Lipton RB, Stewart WF, Celentano DD, et al. Undiagnosed migraine headaches: a comparison of symptom-based and reported physician diagnosis. Arch Intern Med 1992; 156: 1273–8.

    Article  Google Scholar 

  31. Lipton RB, Silberstein SD, Stewart WF. An update on the epidemiology of migraine. Headache 1994; 34: 319–28.

    Article  PubMed  CAS  Google Scholar 

  32. Lofland JH, Johnson NE, Batenhorst AS, et al. Changes in resource use and outcomes for patients with migraine treated with sumatriptan. Arch Intern Med 1999; 159: 857–63.

    Article  PubMed  CAS  Google Scholar 

  33. Dahlof C. Assessment of health-related quality of life in migraine. Cephalalgia 1993; 13: 233–7.

    Article  PubMed  CAS  Google Scholar 

  34. de Lissovoy G, Lazarus SS. The economic cost of migraine/present state of knowledge. Neurology 1994; 44: S56–62.

    PubMed  Google Scholar 

  35. Solomon GD. Quality-of-life assessment in patients with headache. Pharmacoeconomics 1994; 6: 34–41.

    Article  PubMed  CAS  Google Scholar 

  36. Osterhaus JT, Townsend RJ, Gandek B, et al. Measuring the functional status and well-being of patients with migraine headaches. Headache 1994; 34: 337–43.

    Article  PubMed  CAS  Google Scholar 

  37. Andrasik F, Kabela E, Quinn S, et al. Psychological functioning of children who have recurrent migraine. Pain 1988; 34: 43–52.

    Article  PubMed  CAS  Google Scholar 

  38. Devlen J. Anxiety and depression in migraine. J Royal Soc Med 1994; 87: 338–41.

    CAS  Google Scholar 

  39. Ferrari M. The economic burden of migraine to society. Pharmacoeconomics 1998; 13: 667–77.

    Article  PubMed  CAS  Google Scholar 

  40. Lofland JH, Kim S, Batenhorst AS, et al. Cost effectiveness and cost benefit of sumatriptan in patients with migraine. Mayo Clin Proc 2001; 76: 1093–101.

    Article  PubMed  CAS  Google Scholar 

  41. Stang PE, Osterhaus JT. Impact of migraine in the United States: data from the national health interview survey. Headache 1993; 33: 29–35.

    Article  PubMed  CAS  Google Scholar 

  42. Cohen JA, Beall DG, Miller DW, et al. Subcutaneous sumatriptan for the treatment of migraine: humanistic, economic, and clinical consequences. Fam Med 1996; 28: 171–7.

    PubMed  CAS  Google Scholar 

  43. Jhingran P, Cady RK, Rubino J, et al. Improvements in health-related quality of life with sumatriptan treatment for migraine. J Med Econ 1996; 42: 36–42.

    CAS  Google Scholar 

  44. Solomon GD, Nielsen K, Miller D. The effects of sumatriptan on migraine: health-related quality of life. Med Interface 1995; Jun: 134–41.

  45. Santanello NC, Polis AB, Hartmaier SL, et al. Improvement in migraine-specific quality of life in a clinical trial of rizatriptan. Cephalalgia 1997; 17: 867–72.

    Article  PubMed  CAS  Google Scholar 

  46. Wells NE. The relevance and application of disease management and pharmacoeconomics to migraine. Funct Neurol 2000; 15 Suppl. 3: 211–8.

    PubMed  Google Scholar 

  47. Adelman JU, Von Seggern R. Cost considerations in headache treatment. Part 1: prophylactic migraine treatment. Headache 1995; 35: 479–87.

    CAS  Google Scholar 

  48. Adelman JU, Brod A, Von Seggern RL, et al. Migraine preventive medications: a reappraisal. Cephalalgia 1998; 18: 605–11.

    Article  PubMed  CAS  Google Scholar 

  49. Jhingran P, Davis SM, LaVange LM, et al. MSQ: Migraine-specific quality-of-life questionnaire. Pharmacoeconomics 1998; 13: 708–17.

    Article  Google Scholar 

  50. Hartmaier SL, Santanello NC, Epstein RS, et al. Development of a brief 24-hour migraine-specific quality of life questionnaire. Headache 1995; 35: 320–9.

    Article  PubMed  CAS  Google Scholar 

  51. McKenna SP, Doward LC, Davery KM. The development and psychometric properties of the MSQOL-A migraine-specific quality-of-life instrument. Clin Drug Invest 1998; 15: 413–23.

    Article  CAS  Google Scholar 

  52. Martin BC, Pathak DS, Sharfman M, et al. Validity and reliability of the migrainespecific quality of life questionnaire (MSQ version 2.1). Headache 2000; 40: 204–15.

    Article  PubMed  CAS  Google Scholar 

  53. Lerner D, Amick III B, Malspeis WH, et al. The migraine work and productivity loss questionnaire: concepts and design. Qual Life Res 1999; 8: 699–710.

    Article  PubMed  CAS  Google Scholar 

  54. Shikar R, Rentz AM, Halpern MT, et al. The health and work questionnaire (hwq): an instrument for assessing workplace productivity in relation to worker health. Value Health 2001; 4 (2): 181.

    Article  Google Scholar 

  55. Davies GM, Santanello N, Gerth W, et al. Validation of a migraine work and productivity loss questionnaire for use in migraine studies. Cephalalgia 1999; 19: 497–502.

    Article  PubMed  CAS  Google Scholar 

  56. Johnson NE. Integration of costs and outcomes measurement. In: Johnson NE, Nash DB, editors. The role of pharmacoeconomics in outcomes management. 1st ed. Chicago (IL): American Hospital Publishing, Inc., 1996: 35–45.

    Google Scholar 

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Acknowledgements

This work was sponsored by the Agency for Health Care Research and Quality K-08 00005 Mentored Clinical Scientist Award and a PhRMA Foundation Grant.

We would like to thank Elizabeth D. Moxey, MPH for her review of the manuscript.

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Authors and Affiliations

  1. Office of Health Policy and Clinical Outcomes, Thomas Jefferson University, 1015 Walnut Street, Suite 115, Philadelphia, PA, 19107, United States

    Jennifer H. Lofland PharmD, MPH (Project Director and Research Assistant Professor) & Purna K. Lakhia

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  1. Jennifer H. Lofland PharmD, MPH
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  2. Purna K. Lakhia
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Correspondence to Jennifer H. Lofland PharmD, MPH.

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Lofland, J.H., Lakhia, P.K. Migraine Prophylaxis in Managed Care Organizations. Dis-Manage-Health-Outcomes 10, 489–494 (2002). https://doi.org/10.2165/00115677-200210080-00005

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