With an estimated prevalence of 8.3% in Canada, migraine is a significant health issue in this country and is associated with a substantial economic and human cost. Neurologist Dr. Farnaz Amoozegar (University of Calgary, Alberta) and her team recently published the results of a cross-sectional observational patient survey and retrospective medical chart review which quantified the clinical, human, and economic burden of patients with migraine in Canada1.
Migraine is classified into three different categories: episodic (EM) in people who experience <15 headache days per month, further subdivided into low-frequency EM (defined as 1 to 7 monthly migraine days) and high-frequency EM (defined as 8 to 14 monthly migraine days), and chronic (CM) in people who experience ≥15 headache days per month, 8 of which are migraine2,3,4.
Economic burden
Migraine is associated with significant disability, and one of the main goals of migraine treatment is to reduce the burden of disease. It is also important to understand this burden in order to better improve patient outcomes1,5.
Current treatment guidelines in Canada recommend abortive medications to manage acute migraine attacks, and preventive medications to prevent migraine attacks.
The most common acute medications include triptans, anti-inflammatories, and analgesics, while common preventive medications include antidepressants, anticonvulsants and antihypertensives. Onabotulinum toxin A is also widely used for prevention of CM, and anti-calcitonin gene-related peptide monoclonal antibodies have recently emerged as migraine-specific preventive agents1,6,7.
Patients included in this study had failed on average three preventive therapies due to lack of efficacy.
The authors of the study aimed to characterize the clinical, humanistic, and economic burden of illness of migraine in Canada. Researchers conducted cross-sectional observational patient surveys and retrospective medical chart reviews of 287 patients who had attended one of five Canadian migraine centers. Patients included in this study had failed on average three preventive therapies due to lack of efficacy or tolerability, thus incurring extra costs in terms of appointments with healthcare providers, diagnostic procedures (lab tests, imaging etc.), medications, and non-surgical interventions.
Direct healthcare costs per person were estimated to be $7,004.16 in low-frequency EM and $8,938.89 in high-frequency EM. The highest annual cost occurred in patients with CM : $12,413.31 per person. CM).
Human burden
Migraine also has a significant impact on individuals' quality of life, including physical, emotional, and social well-being. Migraine can impact a person’s capacity to work or study, their participation in family activities, and their ability to engage in normal activities of daily living 5.
To assess this, investigators used 3 different validated patient-reported outcome (PRO) instruments (Headache Impact Test [HIT-6TM], EQ-5D, Migraine-Specific Quality of Life Questionnaire [MSQ]) to explore the impact of migraine on patients’ lives. Importantly, 38% of the patients in this study also experienced anxiety/depression.
The study also examined the Migraine Disability Assessment (MIDAS) and Work Productivity and Activity Impairment (WPAI) questionnaires to assess disability and lost work productivity; 61.3% of patients reported an average of 60.6 days in which their productivity was reduced by ≥50% due to their migraines.
61.3% of patients reported an average of 60.6 days in which their productivity was reduced by ≥50% due to their migraines.
Indirect costs, consisting of direct non-healthcare costs and indirect costs (lost productivity) accounted for over 50% of the total economic burden for both EM and CM. The indirect (annual) costs of migraine per person were estimated to be $8647.19 in low-frequency EM, $15,945.90 in high-frequency EM and $13,255.58 in CM.
Adding together both direct and indirect costs, the total estimated annual $25.669 per patient with CM, $24,885 per patient with HFEM, and $15,651 in LFEM. The authors highlighted the fact that the burden of migraine in patients with HFEM is considerably higher than in LFEM, and approaches the burden associated with CM.
Adding together both direct and indirect costs, the total estimated annual $25.669 per patient with CM, $24,885 per patient with HFEM, and $15,651 in LFEM.
This analysis demonstrates that migraines constitute a substantial economic and human cost to the Canadian healthcare system. It is essential to address this health issue through increased awareness, education, and funding for research and treatment options to improve the quality of life and reduce the economic and human burden for all those affected by this debilitating condition.
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