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Economic burden of medication-overuse headache in Iran: direct and indirect costs

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Abstract

Background and objective

Medication-overuse headache (MOH) as a secondary chronic headache imposes a considerable burden on both individuals and societies. Nevertheless, little is known about the burden of MOH in Iran. Therefore, in the current study, we aimed to quantify the annual cost of MOH among Iranian patients.

Methods

In this cross-sectional study, 84 patients were recruited. Demographic data, headache attack characteristics, related disability, and information about the economic burden of MOH were collected through face-to-face interview. Direct medical and nonmedical costs as well as indirect costs were included in our cost analysis. The prevalence-based approach was applied to estimate the economic burden of MOH.

Results

We found that MOH patients in Iran spend averagely $1046 for medical services, $132 for nonmedical services, and $1432 due to lost productivity per year. The per-person annual cost of MOH was US$2610, and the total annual cost for Iran was $10,179,000,000, with direct and indirect cost accounting for 45% and 55%, respectively.

Conclusion

MOH leads to substantial healthcare costs and significant loss of productivity in Iran. Therefore, raising awareness in this area especially for policymakers can use in future health planning and lead to resource allocation in the field of disabling type of headache disorders such as MOH. Our findings also provide a different insight into the burden of MOH, which are likely closer to the actual costs in middle- and low-income countries, and also it could be a sample of such a study in western Asia.

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Data availability

Not applicable.

Abbreviations

GBD:

Global Burden of Disease

DALYs:

Disability-adjusted life-years

MOH:

Medication-overuse headache

TTH:

Tension-type headache

MIDAS:

Migraine Disability Assessment test

VAS:

Visual analogue scale

NSAIDs:

Nonsteroidal anti-inflammatory drugs

GP:

General practitioner

TCAs:

Tricyclic antidepressants

GDP:

Gross domestic product

References

  1. Organization WH (2011) Atlas of headache disorders and resources in the world 2011. World Health Organisation, Geneva

    Google Scholar 

  2. Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P (2015) Headache disorders are third cause of disability worldwide. BioMed Central 16 (58)

  3. Abbastabar H, Bitarafan S, Harirchian MH (2019) The trend of incidence and burden of neurological disease in Iran between 1990 and 2017: based on global burden of disease estimations. Iran J Neurol 18(3):134

    PubMed  PubMed Central  Google Scholar 

  4. Mennini FS, Gitto L, Martelletti P (2008) Improving care through health economics analyses: cost of illness and headache. J Headache Pain 9(4):199

    Article  Google Scholar 

  5. Linde M, Gustavsson A, Stovner LJ, Steiner TJ, Barré J, Katsarava Z et al (2012) The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol 19(5):703–711

    Article  CAS  Google Scholar 

  6. Vos T, Abajobir A, Hassen Abate K, Abbafati C, Abbas K, Abd-Allah F, et al. (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 390(10100):1211–1259

  7. Westergaard ML, Munksgaard SB, Bendtsen L, Jensen RH (2016) Medication-overuse headache: a perspective review. Ther Adv Drug Saf 7(4):147–158

    Article  Google Scholar 

  8. Martelletti P (2011) Dispute settlement understanding on the use of BOTOX® in chronic migraine. BioMed Central 12(1–2)

  9. Shahbeigi S, Fereshtehnejad S-M, Mohammadi N, Golmakani MM, Tadayyon S, Jalilzadeh G et al (2013) Epidemiology of headaches in Tehran urban area: a population-based cross-sectional study in district 8, year 2010. Neurol Sci 34(7):1157–1166

    Article  Google Scholar 

  10. Steiner TJ, Stovner LJ, Katsarava Z, Lainez JM, Lampl C, Lantéri-Minet M et al (2014) The impact of headache in Europe: principal results of the Eurolight project. J Headache Pain 15(1):31

    Article  Google Scholar 

  11. Lantéri-Minet M, Duru G, Mudge M, Cottrell S (2011) Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: a systematic review. Cephalalgia. 31(7):837–850

    Article  Google Scholar 

  12. Blumenfeld A, Varon S, Wilcox T, Buse D, Kawata A, Manack A et al (2011) Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 31(3):301–315

    Article  CAS  Google Scholar 

  13. Lanteri-Minet M (2014) Economic burden and costs of chronic migraine. Curr Pain Headache Rep 18(1):385

    Article  Google Scholar 

  14. Burch R, Rizzoli P, Loder E (2018) The prevalence and impact of migraine and severe headache in the United States: figures and trends from government health studies. Headache 58(4):496–505

    Article  Google Scholar 

  15. Buse DC, Lipton RB (2013) Global perspectives on the burden of episodic and chronic migraine. Sage Publications Sage UK, London

    Book  Google Scholar 

  16. Mossey JM (2011) Defining racial and ethnic disparities in pain management. Clin Orthop Relat Res 469(7):1859–1870

    Article  Google Scholar 

  17. Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N et al (2019) Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 18(5):459–480

    Article  Google Scholar 

  18. Shah AM, Bendtsen L, Zeeberg P, Jensen RH (2013) Reduction of medication costs after detoxification for medication-overuse headache. Headache 53(4):665–672

    Article  Google Scholar 

  19. Jellestad PL, Carlsen LN, Westergaard ML, Munksgaard SB, Bendtsen L, Lainez M et al (2019) Economic benefits of treating medication-overuse headache–results from the multicenter COMOESTAS project. Cephalalgia. 39(2):274–285

    Article  Google Scholar 

  20. FDA. Drug Information Website Available from: http://irc.fda.gov.ir/nfi

  21. Ministry of cooperatives labour and social welfare. Available from: https://www.mcls.gov.ir/fa/rahnamayemorajein/karegaran

  22. Statistical Center of Iran. Population and Housing Censuses Available from: https://www.amar.org.ir/english/Population-and-Housing-Censuses

  23. D’Amico D, Grazzi L, Curone M, Leonardi M, Raggi A (2017) Cost of medication overuse headache in Italian patients at the time-point of withdrawal: a retrospective study based on real data. Neurol Sci 38(1):3–6

    Article  Google Scholar 

  24. Raggi A, Leonardi M, Sansone E, Curone M, Grazzi L, D’Amico D (2020) The cost and the value of treatment of medication overuse headache in Italy: a longitudinal study based on patient-derived data. Eur J Neurol 27(1):62–e1

    Article  CAS  Google Scholar 

  25. World Bank. Adjusted net national income per capita (current US$) (2017) Available from: https://data.worldbank.org/indicator/NY.ADJ.NNTY.PC.CD

  26. International Monetary Fund. Gross domestic product per capita, current prices 2019 Available from: https://www.imf.org/external/pubs/ft/weo/2019/02/weodata/index.aspx

  27. World Bank. GDP per capita (current US$) (2017) Available from: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD

  28. Raggi A, Leonardi M, Scaratti C, Sansone E, Grazzi L, D’Amico D (2018) Gender and education inequalities in the cost of medication-overuse headache. Neurol Sci 39(1):117–119

    Article  Google Scholar 

  29. Takeshima T, Wan Q, Zhang Y, Komori M, Stretton S, Rajan N et al (2019) Prevalence, burden, and clinical management of migraine in China, Japan, and South Korea: a comprehensive review of the literature. J Headache Pain 20(1):111

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mansoureh Togha

  2. Headache Department, Neurology Ward, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Mansoureh Togha & Fahimeh Martami

  3. Eye Research Center, The Five Senses Institute Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

    Fatemeh Nadjafi-Semnani

  4. Shariari Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Zahra Mohammadshirazi

  5. Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Niusha Vahidpour

  6. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Ali Akbari-sari & Rajabali Daroudi

Authors
  1. Mansoureh Togha
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  2. Fatemeh Nadjafi-Semnani
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  3. Fahimeh Martami
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  4. Zahra Mohammadshirazi
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  5. Niusha Vahidpour
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  6. Ali Akbari-sari
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  7. Rajabali Daroudi
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Fatemeh Nadjafi-Semnani. Zahra Mohammadshirazi and Niusha vahidpour were also involved in data collection process. Data analysis was performed by Ali Akbari-sari and Rajabali Daroudi. The first draft of the manuscript was written by Mansoureh Togha and Fahimeh Martami. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mansoureh Togha.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the ethical committee of Tehran University of medical sciences (IR.TUMS.MEDICINE.REC.1397.177).

Consent to participate

All patients signed an informed consent form prior to inclusion in the study.

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Mansoureh Togha and Fahimeh Martami are equally first authors.

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Togha, M., Nadjafi-Semnani, F., Martami, F. et al. Economic burden of medication-overuse headache in Iran: direct and indirect costs. Neurol Sci 42, 1869–1877 (2021). https://doi.org/10.1007/s10072-020-04716-8

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  • DOI: https://doi.org/10.1007/s10072-020-04716-8

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