OBJECTIVES: To evaluate all-cause annual inpatient, outpatient, and pharmacy healthcare costs associated with patients with migraine by different intensities of treatment-seeking behavior.

METHODS: Retrospective analysis of administrative claims using IBM MarketScan^® Commercial and Medicare Databases from 1/1/2016 through 12/31/2017 was conducted with the index date of 1/1/2017. Adult patients with ≥1 migraine medical claim in pre-index year (2016), with continuous enrollment throughout study period, and without malignancy were eligible. Annual all-cause post-index year (2017) costs were evaluated using multivariate regression techniques controlling for demographics and baseline clinical characteristics. Patients were stratified by intensity of treatment-seeking behavior observed in pre-index year, which were based on combinations of utilization of outpatient (OP) and inpatient (IP) services and acute (ARx) and preventive (PRx) prescription migraine medications. Outpatient services consisted of emergency room, physician, hospital, and other outpatient visits.

RESULTS: 338,584 patients (mean age, 44 years; 82% female) met the study criteria. Most common comorbidities included non-headache pain (64%), hypertension (26%), and anxiety (23%). Adjusted mean all-cause annual costs ranged from $6,620 in OP-only cohort to $30,759 in OP+IP with/without (±) ARx cohort. Further adjusted mean all-cause inpatient costs ranged from $23,165 in OP-only to $44,182 in OP+IP±ARx cohorts. Adjusted mean outpatient costs ranged from $4,129 in OP-only to $16,086 in OP+IP±ARx cohorts. Use of OP+ARx and/or OP+PRx was associated with increased outpatient costs from $5,942 to $9,987 compared to OP-only. Adjusted mean pharmacy costs ranged from $1,596 in OP+ARx to $6,861 in OP+IP±ARx cohorts.

CONCLUSIONS: Increases in intensity of treatment-seeking behavior, defined by use of migraine-specific medical and pharmacy services, were associated with incremental rises in annual healthcare expenditures, including inpatient, outpatient, and pharmacy costs. Effective migraine prevention therapies may have potential to reduce the treatment-seeking behavior intensity and, therefore, associated economic migraine burden.