ECONOMIC OUTCOMES, REAL-WORLD ADHERENCE PATTERNS AND PREDICTIVE MODELING OF MIGRAINE PROPHYLAXIS: A RETROSPECTIVE COHORT STUDY OF TRIPTANS, BETA-BLOCKERS, AND COMBINATION THERAPY
Author(s)
Vikash Kumar Verma, MBA, PharmD1, Louis Brooks Jr, MS2, Marissa Seligman, PharmD3, Abhimanyu Roy, MBA4, Abhinav Nayyar, MBA, MBBS5, Ankitkumar Arora, MPharm6, Anuj Gupta, MSc7, Komal Chauhan, Other7, Vishan Khatavkar, MBA8, Solomon Sundaram, Other9, Gargi Shukla, MBA10, Ankita Shrikant Gaonkar, MSc5, Trishala N. Amin, MA11, Arunima Sachdev, MA4, Satish Kumar, MBA8, Kirti Batra, MBA12.
1Optum Lifesciences, Boston, MA, USA, 2Optum, Bloomsbury, NJ, USA, 3Optum Lifesciences, Winchester, MA, USA, 4Optum, Gurgaon, India, 5Optum Life Sciences, Gurugram, India, 6Optum Global Solutions, Gurgaon, India, 7Optum Lifesciences, Noida, India, 8Optum Lifesciences, Gurugram, India, 9Optum Life Sciences, gurugram, India, 10Optum Global Solutions, Gurugram, India, 11Optum Life Sciences, Behrampur, India, 12Optum Global Solutions, Noida, India.
1Optum Lifesciences, Boston, MA, USA, 2Optum, Bloomsbury, NJ, USA, 3Optum Lifesciences, Winchester, MA, USA, 4Optum, Gurgaon, India, 5Optum Life Sciences, Gurugram, India, 6Optum Global Solutions, Gurgaon, India, 7Optum Lifesciences, Noida, India, 8Optum Lifesciences, Gurugram, India, 9Optum Life Sciences, gurugram, India, 10Optum Global Solutions, Gurugram, India, 11Optum Life Sciences, Behrampur, India, 12Optum Global Solutions, Noida, India.
OBJECTIVES: To assess real-world treatment adherence, rescue medication utilization, healthcare resource utilization, and associated costs among migraine patients treated with triptans, beta-blockers, or combination therapy. Additionally, to develop predictive models to identify key factors contributing to non-adherence or treatment discontinuation.
METHODS: A retrospective analysis was conducted using Optum’s® de-identified Market Clarity database. Adults aged ≥18 years with at least one migraine diagnosis and one prescription for triptans, beta-blockers, or both were included. The study period was July 2021-June 2025; the index period was July 2022-June 2023. The index date was the earliest prescription of triptans or beta-blockers linked to a migraine diagnosis. Continuous enrollment for 12 months pre‑ and post‑index was required. Patients with secondary headache disorders or use of other preventive migraine therapies were excluded. Cohorts comprised: triptans‑only, beta‑blockers‑only, and combination therapy.
RESULTS: After applying inclusion and exclusion criteria, cohort sample sizes were: triptans-only (n = 3,175), beta-blockers-only (n = 191), and combination therapy (n = 114). Adherence (PDC ≥80%) was low across all groups: 20.85% for triptans, 32.46% for beta‑blockers, and 34.21% for combination therapy. Mean rescue medication use remained modest (0.17, 0.18, and 0.20 fills, respectively). Emergency department (ED) visits occurred in 32.94% (triptans), 35.60% (beta‑blockers), and 37.72% (combination therapy) of patients; inpatient visits in 14.11%, 20.94%, and 18.42%, respectively. Total annual healthcare costs averaged $40,781, $40,307, and $36,486 for the respective cohorts. Medical costs were highest in the beta‑blocker cohort ($25,025), while pharmacy costs were highest among triptan users ($21,951). Patients in the combination group incurred comparatively lower total costs.
CONCLUSIONS: Migraine therapy adherence is suboptimal across cohorts; combination therapy shows slightly better adherence and lower costs than monotherapy. Rescue medication uses and acute care visits persist, driving economic burden.
METHODS: A retrospective analysis was conducted using Optum’s® de-identified Market Clarity database. Adults aged ≥18 years with at least one migraine diagnosis and one prescription for triptans, beta-blockers, or both were included. The study period was July 2021-June 2025; the index period was July 2022-June 2023. The index date was the earliest prescription of triptans or beta-blockers linked to a migraine diagnosis. Continuous enrollment for 12 months pre‑ and post‑index was required. Patients with secondary headache disorders or use of other preventive migraine therapies were excluded. Cohorts comprised: triptans‑only, beta‑blockers‑only, and combination therapy.
RESULTS: After applying inclusion and exclusion criteria, cohort sample sizes were: triptans-only (n = 3,175), beta-blockers-only (n = 191), and combination therapy (n = 114). Adherence (PDC ≥80%) was low across all groups: 20.85% for triptans, 32.46% for beta‑blockers, and 34.21% for combination therapy. Mean rescue medication use remained modest (0.17, 0.18, and 0.20 fills, respectively). Emergency department (ED) visits occurred in 32.94% (triptans), 35.60% (beta‑blockers), and 37.72% (combination therapy) of patients; inpatient visits in 14.11%, 20.94%, and 18.42%, respectively. Total annual healthcare costs averaged $40,781, $40,307, and $36,486 for the respective cohorts. Medical costs were highest in the beta‑blocker cohort ($25,025), while pharmacy costs were highest among triptan users ($21,951). Patients in the combination group incurred comparatively lower total costs.
CONCLUSIONS: Migraine therapy adherence is suboptimal across cohorts; combination therapy shows slightly better adherence and lower costs than monotherapy. Rescue medication uses and acute care visits persist, driving economic burden.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
MSR161
Topic
Methodological & Statistical Research
Topic Subcategory
Artificial Intelligence, Machine Learning, Predictive Analytics
Disease
SDC: Neurological Disorders