Wertz Debra A, Quimbo Ralph M, Yaldo Avin Z, Rupnow Marcia F T
Health Outcomes Research, HealthCore, Inc, Wilmington, DE 19801, USA.
Curr Med Res Opin. 2009 Feb;25(2):499-503. doi: 10.1185/03007990802664199.
To determine the pattern of headache-related resource utilization and costs before and after initiation of preventive migraine treatment with topiramate in a sample of a large managed-care population.
This study was a retrospective, longitudinal, cohort study analysis of medical and pharmacy claims using The HealthCore Integrated Research Network Database. Patients were required to have had at least one pharmacy claim for topiramate between 7/1/00 and 11/30/04, and at least 12 dosage units dispensed of any combination of acute migraine treatments (triptan, ergotamine, or ergotamine combination) during the 6-month period preceding the first pharmacy claim for topiramate (the index date). Headache-related inpatient and outpatient resource utilizations were compared pre-index vs. post-index period 1 (months 1-6) and pre-index vs. post-index period 2 (months 7-12). Statistical analyses included McNemar tests for categorical variables and paired t-tests for continuous variables.
A total of 3246 patients met the inclusion criteria. The mean (+/- SD) age was 44 +/- 10 years and 88% were female. From pre- to post-index period 2, outpatient visits significantly decreased by 30% (p < 0.0001), diagnostic procedures decreased by 74% (p = 0.0013), emergency room (ER) visits decreased by 27% (p < 0.0001), and abortive prescriptions decreased by 25% (p < 0.0001). No significant differences were found in mean number of hospitalization days. Total headache-related inpatient costs and outpatient costs decreased (p < 0.01) during post-index period 2 (43 and 46%, respectively). Headache-related pharmacy costs increased from pre- to post-index period 2.
Topiramate treatment for migraine prevention was associated with significantly lower healthcare resource use (ER visits, diagnostics, acute treatment) in the first 6 months of treatment, with continuing decreases, including physician office visits, during the second 6 months of treatment.
Since this study is a claims-based analysis there is the potential introduction of non-claims identifiable factors that might influence resource use such as lifestyle modifications and over-the-counter medications. In addition, adherence to topiramate treatment was not accounted for in this study. Nonetheless, this study provides important insights into the benefit of preventive migraine treatment in actual clinical practice.
在一个大型管理式医疗人群样本中，确定托吡酯预防性治疗偏头痛开始前后与头痛相关的资源利用情况及成本。
本研究是一项利用HealthCore综合研究网络数据库对医疗和药房理赔数据进行的回顾性、纵向队列研究分析。患者需在2000年7月1日至2004年11月30日期间至少有一张托吡酯的药房理赔记录，且在首次托吡酯药房理赔记录（索引日期）前6个月内至少配出12个剂量单位的任何急性偏头痛治疗药物组合（曲坦类、麦角胺或麦角胺组合）。比较索引前与索引后第1期（1 - 6个月）以及索引前与索引后第2期（7 - 12个月）与头痛相关的住院和门诊资源利用情况。统计分析包括分类变量的McNemar检验和连续变量的配对t检验。
共有3246例患者符合纳入标准。平均（±标准差）年龄为44±10岁，88%为女性。从索引前到索引后第2期，门诊就诊次数显著减少30%（p < 0.0001），诊断程序减少74%（p = 0.0013），急诊室就诊次数减少27%（p < 0.0001），中止处方减少25%（p < 0.0001）。住院天数的平均数无显著差异。索引后第2期，与头痛相关的住院总费用和门诊费用均下降（p < 0.01）（分别下降43%和46%）。从索引前到索引后第2期，与头痛相关的药房费用增加。
托吡酯预防偏头痛治疗在治疗的前6个月与显著降低医疗资源使用（急诊室就诊、诊断、急性治疗）相关，在治疗的后6个月包括医师门诊就诊次数持续减少。
由于本研究是基于理赔的分析，可能会引入一些无法通过理赔识别的因素，这些因素可能会影响资源使用，如生活方式改变和非处方药。此外，本研究未考虑托吡酯治疗的依从性。尽管如此，本研究为实际临床实践中预防性偏头痛治疗的益处提供了重要见解。
