Real World Objectively Measured Productivity Losses of Employees With Migraines and the Use of Calcitonin Gene-Related Peptide Inhibitors in United States Employees

OBJECTIVES: Migraine is associated with high disability rates especially among those needing preventative medications. Calcitonin gene-related peptide inhibitors (CGRPis) are newer preventative medications often requiring prior authorization with a documented diagnosis and migraine frequency. To characterize migraine diagnoses, prescriptions and short-term disability (STD) claims of employees with migraines and those initiating CGRPis from 2017—2022.

METHODS: Retrospective analysis of WorkPartners' Research Reference Database (2017—2022) of employees with an initial migraine Dx (ICD-10=G43.x). Employees had ≥1 year eligibility post-Dx with continuous data into 2023. Patients with migraines (migraineurs) reported based on initial Dx-year. Outcomes included direct (plan plus employee medical+prescription) costs, indirect costs, and lost days due to STD-claims (with a migraine-Dx) anytime post-index, initial and use of CGRPi in 2023. Costs were inflation-adjusted to December-2023 United States $s.

RESULTS: 16,588 migraineurs were identified with ≥77.9% females each year and an average of 13.8% had CGRPi claims. Overall migraine STD-claims anytime post-index Dx annually decreased from 2.4%→ 0.7%, mean STD-claim durations ranged from 37→58.2 lost days/claim, and mean STD-costs/claim ranged from $6,368—$12,370 with lost STD-days/employee decreasing from 1.5→0.3 days. Migraineurs initiating a CGRPi <12months post-Dx increased annually from 2017 (0.9%→88.4%) in 2022, and those still using a CGRPi in 2023 increased annually from 0.4%→75% with mean time until the first CGRPi claim decreasing annually from 3.3→0.4 years. In the year post-Dx, mean CGRPi claims ranged from 1.3—6.3 days with mean direct cost/CGRPi claim decreasing from $539 in 2017 before increasing in 2018 from $470→$758 in 2022. CGRPi migraineurs' mean STD-claims anytime post-CGRPi ranged from 1.4%—3.7%, with mean claims ranging from 44.9—66.6 lost days/claim, and mean costs/claim ranging from $8685—$16,679.

CONCLUSIONS: Use of CGRPis has increased significantly among employees since their introduction in 2018. Employees who initiated a CGRPi had a higher proportion of STD-claims and costs/claim than a typical employee with migraine.