OBJECTIVES: Migraine is treated with many preventative and acute therapies. A stepwise approach should be used to limit spending with cost effective evidence-driven therapies. The high cost of Botulinum Toxin (BT) leads to fears of misuse due to similar route of administration to cosmetic application. Little is known about differences in demographics and costs between migraineurs using BT to those who do not.

METHODS: A retrospective analysis was conducted using a multi-employer pharmacy and medical claims database with over 1 million lives for the year 2021 provided by Gallagher benefits consulting. We first identified those with a migraine diagnosis using ICD-10 codes including the root base G43 (excluding abdominal migraine). Then, we identified the members who had a BT claim using NDC codes for all formulations or by CPT codes related to BT treatment. We summarize descriptive statistics for the variables of interest.

RESULTS: 40,153 migraineurs were included in the analysis. Of these, 2,738 (6.82%) had a claim for BT. Females represented 82.8% of migraineurs without BT claims, and 91.0% of those with claims. 51.9% of migraineurs using BT were in the 40-54 age group and 28.4% were <40. 56.7% of BT migraineurs did not have claims for acute therapy and 45.3% did not have claims for any other preventative. Median total claim cost per member without BT claims was $3,706 (IQR: $1,055-$11,977), whereas median total claim costs for those with BT claims was $14,305 (IQR: $6,669-$31,699). Median percentage of claim costs attributable to BT claims were 20% (IQR:7%-43%).

CONCLUSIONS: BT prevalence in employed migraineurs is low, however other therapies may not be commonly prescribed prior to its use. Total claim costs for BT utilizers were four-fold higher than other migraineurs, with BT associated claims significantly contributing to total costs. Further analyses are warranted to evaluate the appropriateness of BT use in migraine sufferers.