Abstract
Objective: To apply a claims-based algorithm to identify potentially undiagnosed chronic migraine (CM) patients and compare 12-month direct costs of potentially undiagnosed versus diagnosed CM patients.
Background: Approximately 7.7% of those with migraine have a CM diagnosis; however, it is estimated that 75% of those with CM are undiagnosed. Little is known about the economic burden of undiagnosed CM.
Design/Methods: Adults having ≥2 migraine diagnoses (346.xx) ≥30 days apart with migraine claims between 7/1/14 and 6/30/15 and continuously enrolled ≥12 months pre- and post-index date were identified from a large US claims database. Patients with ≥2 CM diagnoses (346.7x) ≥30 days apart were assigned to diagnosed CM cohort. A recently developed algorithm was applied to identify potentially undiagnosed CM patients from the group of migraine patients without diagnosed CM (ie, no claim for 346.7x or onabotulinumtoxinA during study period). Algorithm predicts CM status based on gender, number of acute medication claims, unique preventive classes, and healthcare visits; it has 78% sensitivity and 73% specificity. The 12-month post-index all-cause costs were compared between diagnosed CM and potentially undiagnosed CM cohorts. Generalized linear models controlling for patient age, gender, region, plan type, comorbidity score, and other migraine-related comorbidities were used to estimate adjusted costs.
Results: Study included 5555 diagnosed CM patients and 12,780 potentially undiagnosed CM patients. Mean adjusted total direct costs were significantly higher for undiagnosed CM group ($26,019) than for diagnosed CM group ($22,826, P<0.05). Mean adjusted medical costs for undiagnosed CM patients ($21,973) were higher than for diagnosed CM patients ($17,433, P<0.05). Mean adjusted pharmacy costs for undiagnosed CM patients ($3856) were lower versus diagnosed CM patients ($4928, P<0.05).
Conclusions: Undiagnosed CM was associated with significantly higher total healthcare costs and direct medical costs than diagnosed CM. Initiatives to better identify and manage such patients are needed.
Disclosure: Dr. Marcus has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan. Dr. Shewale has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities as a full-time employee of Allergan plc. Dr. Shewale holds stock and/or stock options in Allergan plc which sponsored research in which Dr. Shewale was involved as an investigator. Dr. Young has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Alder, Allergan, Cipla, Lilly, Supernus. Dr. Young has received research support from AGA, Alder, Allergan, Amgen, Autonomic Technology, Cumberland, Dr. Reddy Laboratories, Eli Lilly, Eneura Inc, Merz, and St. Jude Medical. Dr. Yu has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Inc. Dr. Yu holds stock and/or stock options in Allergan, Inc. Dr. Pavlovic has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Alder Pharmaceuticals, Allergan, Dr. Reddy’s Laboratories, and the American Headache Society. Dr. Viswanathan has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Inc. Dr. Viswanathan holds stock and/or stock options in Allergan, Inc., which sponsored research in which Dr. Viswanathan was involved as an investigator. Dr. Viswanathan holds stock and/or stock options in Allergan, Inc. Dr. Doshi has received personal compensation for consulting for Alkermes, Forest Laboratories (now Allergan), Ironwood Pharmaceuticals, Shire, and Vertex Pharmaceuticals. Dr. Doshi holds stock and/or stock options in Merck and Pfizer, which sponsored research in which Dr. Doshi was involved as an investigator. Dr. Doshi has received research support from has previously received research funding from AbbVie, Biogen, Humana, Janssen, PhRMA, Pfizer, Regeneron, Sanofi, and the National Pharmaceutical Council.
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