Silberstein Stephen D, Feliu Anthony L, Rupnow Marcia F T, Blount Angela C, Boccuzzi Stephen J
Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Headache. 2007 Apr;47(4):500-10. doi: 10.1111/j.1526-4610.2007.00754.x.
To evaluate the medical resource utilization and overall cost of care among patients treated with topiramate (TPM) for migraine prevention in a commercially insured population. Background.-Preventive migraine therapy with TPM significantly reduces the frequency of migraine attacks. Limited data exist on the real-world health care consumption associated with TPM therapy for migraine prevention.
Data were obtained from a large geographically diverse integrated medical and pharmacy claims database representative of the commercially insured population. The date of the first TPM claim between July 2000 and December 2003 was considered the index date. Patients needed at least 1 triptan prescription (Rx) claim during the 6-month preindex period, and > or =2 TPM Rx claims in the 12 months following index TPM Rx to be included in the analysis. Headache-related inpatient and outpatient resource use were compared: preindex vs postindex period 1 (months 1-6) and preindex vs postindex period 2 (months 7-12). Subgroup analyses were conducted based on the triptan consumption during the 6-month preindex period: Cohort L (low triptan users) with < or =36 triptan doses, and Cohort H (high triptan users) with >36 triptan doses.
The sample included 2645 plan members (1778 patients in Cohort L, and 867 patients in Cohort H). TPM utilization was associated with significantly less triptan utilization in the first (34.8 quantity dispensed; 7.5% decrease) and second (30.2; 19.6% decrease) follow-up periods compared to the preindex period (37.6; both P < .0001). In postindex period 1, there was a 46% decrease in emergency department (ED) visits, 39% decrease in diagnostic procedures (eg, CT scans and MRIs), and a 33% decrease in hospital admission; physician office visits were unchanged. In postindex period 2, there was a 46% decrease in ED visits, 72% decrease in diagnostic procedures, 61% decrease in hospital admissions, and a 35% decrease in physician office visits. Decreases in resource use were observed in both cohorts L and H. Mean +/- SD total headache-related cost was $2118 +/- $3406 per patient in the preperiod, versus $2450 +/- $3318 in follow-up period 1 and $2009 +/- $3136 in follow-up period 2.
In this sample of patients from a diverse set of health plans receiving TPM, significant decreases in resource use were observed within 6 months of TPM initiation, and this trend continued in follow-up period 2. Although there was an initial increase in total headache-related cost upon introduction of TPM (follow-up period 1), the cost in follow-up period 2 was lower than in the preindex period, suggesting that benefits of long-term treatment with TPM can be achieved without increasing total cost.
评估在商业保险人群中，使用托吡酯（TPM）预防偏头痛的患者的医疗资源利用情况及总体护理成本。背景：TPM预防性偏头痛治疗可显著降低偏头痛发作频率。关于TPM预防偏头痛治疗在现实世界中的医疗保健消耗的数据有限。
数据来自一个代表商业保险人群的大型地理分布广泛的综合医疗和药房理赔数据库。2000年7月至2003年12月期间首次开具TPM处方的日期被视为索引日期。患者在索引前6个月期间至少需要1次曲坦类药物处方（Rx）理赔，且在索引TPM Rx后的12个月内需要≥2次TPM Rx理赔才能纳入分析。比较了与头痛相关的住院和门诊资源使用情况：索引前与索引后第1期（1 - 6个月）以及索引前与索引后第2期（7 - 12个月）。根据索引前6个月期间的曲坦类药物消耗情况进行亚组分析：队列L（低曲坦类药物使用者），曲坦类药物剂量≤36剂；队列H（高曲坦类药物使用者），曲坦类药物剂量>36剂。
样本包括2645名计划成员（队列L中有1778名患者，队列H中有867名患者）。与索引前时期相比，TPM的使用在第一个随访期（配发量34.8；减少7.5%）和第二个随访期（30.2；减少19.6%）与曲坦类药物使用的显著减少相关（索引前时期为37.6；P均<.0001）。在索引后第1期，急诊就诊减少46%，诊断程序（如CT扫描和MRI）减少39%，住院减少33%；医师门诊就诊未变。在索引后第2期，急诊就诊减少46%，诊断程序减少72%，住院减少61%，医师门诊就诊减少35%。在队列L和队列H中均观察到资源使用的减少。头痛相关的平均总费用±标准差在前期为每位患者2118美元±3406美元，在随访期1为2450美元±3318美元，在随访期2为2009美元±3136美元。
在这个来自不同健康计划的接受TPM治疗的患者样本中，在开始使用TPM的6个月内观察到资源使用显著减少，并且这种趋势在随访期2持续。尽管在引入TPM后（随访期1）头痛相关的总费用最初有所增加，但随访期2的费用低于索引前时期，表明长期使用TPM治疗的益处可以在不增加总成本的情况下实现。
