Morey Veronica, Rothrock John F
Department of Neurology, University of South Alabama, Mobile, AL, USA.
Headache. 2008 Jun;48(6):939-43. doi: 10.1111/j.1526-4610.2008.01165.x.
Management options currently are limited for patients with acute migraine whose symptoms prove refractory to self-administered therapy.
To evaluate the clinical utility and cost-effectiveness of a management program offering in-clinic "rescue" treatment for patients with acute migraine.
Two hundred consecutive migraine patients presenting to a university-based headache clinic were randomized to receive either optimal self-administered medical therapy for acute migraine ("standard therapy") or similar therapy plus the option of in-clinic parenteral drug administration should self-administered therapy prove ineffective ("rescue therapy"). Patients randomized to the latter group were restricted to a maximum of 2 "rescue visits" per month, and all patients were followed for one year. Patients "rescued" in clinic were contacted by telephone 24 hours following treatment to evaluate their treatment response. The primary analysis involved a comparison of the number of emergency department (ED) visits for headache recorded within each group over the one-year period of study. For all ED visits in the rescue group and for a randomly selected and equal number of ED visits within the standard group, the direct costs associated with those visits were assessed, and the direct costs of all in-clinic rescue visits also were recorded and analyzed.
The 2 groups studied were similar in terms of age, gender ratio, migraine subtype, migraine-related disability status at baseline and type/extent of medical insurance coverage. Over the one-year study period, the rescue group recorded 423 in-clinic rescue visits and reported 27 ED visits for headache treatment. The standard therapy group reported 73 ED visits (27 vs 73 visits; P < .01). The total direct costs associated with ED visits were $45,330 for the rescue group (mean $1690 per ED visit) and (by extrapolation from the sample selected) $147,971 for the standard therapy group (mean $2027 per ED visit). The total direct cost of the 423 "rescue visits" was $33,647 (mean $80 per visit). In 79% of the 423 rescue encounters, the patients involved reported no residual functional disability 24 hours following treatment. Of those in the rescue group who sought in-clinic rescue, 89% reported themselves "very satisfied" with such management.
Providing the alternative of in-clinic "rescue" for acute migraine refractory to self-administered therapy offers an attractive alternative for patients and appears to substantially lower use of an ED for headache treatment and the cost associated with that use.
对于症状经自我治疗无效的急性偏头痛患者，目前的治疗选择有限。
评估为急性偏头痛患者提供门诊“急救”治疗的管理方案的临床实用性和成本效益。
连续200例到大学头痛门诊就诊的偏头痛患者被随机分为两组，一组接受急性偏头痛的最佳自我药物治疗（“标准治疗”），另一组接受类似治疗，并且如果自我治疗无效可选择门诊注射药物治疗（“急救治疗”）。随机分到后一组的患者每月最多限制进行2次“急救就诊”，所有患者随访一年。对在门诊接受“急救”的患者在治疗后24小时进行电话随访，以评估其治疗反应。主要分析是比较两组在一年研究期内记录的因头痛到急诊科就诊的次数。对于急救组的所有急诊科就诊以及标准组中随机选择的同等数量的急诊科就诊，评估与这些就诊相关的直接费用，并且记录和分析所有门诊急救就诊的直接费用。
研究的两组在年龄、性别比例、偏头痛亚型、基线时与偏头痛相关的残疾状况以及医疗保险覆盖类型/范围方面相似。在一年的研究期内，急救组记录了423次门诊急救就诊，并报告了27次因头痛治疗到急诊科就诊。标准治疗组报告了73次急诊科就诊（27次对73次；P <.01）。急救组与急诊科就诊相关的总直接费用为45,330美元（每次急诊科就诊平均1690美元），标准治疗组（根据所选样本推断）为147,971美元（每次急诊科就诊平均2027美元）。423次“急救就诊”的总直接费用为33,647美元（每次就诊平均80美元）。在423次急救就诊中，79%的患者在治疗后24小时报告无残余功能残疾。在急救组中寻求门诊急救的患者中，89%报告对这种管理“非常满意”。
为自我治疗无效的急性偏头痛患者提供门诊“急救”选择为患者提供了一种有吸引力的替代方案，并且似乎大大降低了因头痛治疗到急诊科就诊的次数以及与之相关的费用。
