OBJECTIVES : Assess the additional costs associated with specific comorbidities in an employer-insured migraine population.

METHODS : A retrospective observational cohort analysis was conducted on beneficiaries aged 18-64 using a multi-employer medical and pharmacy claims database provided by Gallagher (benefits consulting organization), for calendar year 2018. The migraine population was identified using ICD diagnosis codes (“confirmed” migraine) as well as previously-published criteria for those with multiple visits for “headache” and/or pharmacy claims for migraine-specific drugs (“suspected” migraine). Multiple Linear regression was used to assess and compare additional costs experienced by beneficiaries with migraine across six different comorbidities (Anxiety, Depression, Fibromyalgia, Hypertension, Panic Disorder and Stroke).

RESULTS : Of 455,205 adults in the database, 14,540 (3.19%) had confirmed migraine and 5,526 (1.21%) met suspected migraine criteria. Prevalence of specified comorbidities varied within the migraine population ranging as high as 23.9% for hypertension to as low as 1.2% for panic disorder. When controlling for age and sex, all comorbidities of interest were associated with a significantly higher total incremental cost. The largest incremental cost increase was seen with the comorbidity of stroke, which contributed an additional $40,509 in allowed charges when compared to migraine alone (p<0.0001). Similarly, Depression contributed an additional $7,453.99 (p<0.0001) in allowed charges and Anxiety contributed an additional $3,161.45 (p<0.0001) in allowed charges when compared to migraine alone.

CONCLUSIONS : These findings suggest that there is a significant increase in the economic burden attributed to the migraine population for the six different comorbidities of interest. Such findings advocate for additional consideration of medical and pharmaceutical care in the migraine population and point to the need for added attention when developing care plans for beneficiaries with migraine. Additionally, supplementary research is needed to determine the degree to which these additional costs should be attributed to migraine’s interaction with the comorbidity versus the comorbidity alone.