Newman Lawrence, Vo Pamela, Zhou Lujia, Lopez Lopez Cristina, Cheadle Andy, Olson Melvin, Fang Juanzhi
Headache Division (LW), NYU Langone Medical Center, NY; Novartis Pharma AG (PV, CLL, MO), Basel, Switzerland; KMK Consulting Inc. (LZ), Morristown, NJ; and Novartis Pharmaceuticals Corporation (AC, JF), East Hanover, NJ.
Neurol Clin Pract. 2021 Jun;11(3):206-215. doi: 10.1212/CPJ.0000000000001076.
To characterize health care utilization (HCU) and associated costs among patients with migraine categorized by the number of preventive treatment failures (TFs; 1 TF, 2 TFs, and 3+ TFs) using real-world data.
This retrospective analysis identified adults with incident migraine diagnosis in the IBM MarketScan Commercial and Medicare Supplemental database between January 1, 2011, and June 30, 2015. TF was defined in the 2 years after the first migraine diagnosis period. One TF, 2 TFs, and 3+ TFs were defined as patients who had received only 2 preventive treatments (PTs), 3 PTs, and 4+ PTs in the 2-year period, respectively. A negative binomial model was used to analyze HCU data, and a 2-part model was used for cost data controlling for the preindex Deyo-Charlson Comorbidity Index.
Overall, 24,282 patients with incident migraine who had failed at least 1 PT were included in the analysis. Of these, 72.7% (n = 17,653) had 1 TF, 20.2% (n = 4,900) had 2 TFs, and 7.1% (n = 1,729) had 3+ TFs. Adjusted annualized rates of all-cause and migraine-specific HCU increased with an increase in the number of TFs (1.4-4 times higher; all < 0.0001 vs 1 TF). The mean total all-cause health care costs were higher by $3,732 (95% confidence interval [CI]: $2,708-$4,588) in patients with 2 TFs and by $8,912 (95% CI: $7,141-$10,822) in patients with 3+ TFs vs those with 1 TF. Outpatient costs were the key drivers of differences in health care costs.
TF in patients with migraine was associated with a substantial resource and cost burden, which increased with the number of TFs.
利用真实世界数据，对按预防性治疗失败次数（TFs；1次TF、2次TF和3次及以上TF）分类的偏头痛患者的医疗保健利用情况（HCU）及相关成本进行特征描述。
这项回顾性分析在IBM MarketScan商业数据库和医疗保险补充数据库中，识别出2011年1月1日至2015年6月30日期间首次诊断为偏头痛的成年人。TF定义为首次偏头痛诊断期后的2年时间内。1次TF、2次TF和3次及以上TF分别定义为在2年期间仅接受过2次预防性治疗（PTs）、3次PTs和4次及以上PTs的患者。采用负二项式模型分析HCU数据，采用两部分模型分析成本数据，并对索引前的Deyo-Charlson合并症指数进行控制。
总体而言，分析纳入了至少1次PT失败的24282例首次诊断为偏头痛的患者。其中，72.7%（n = 17653）有1次TF，20.2%（n = 4900）有2次TF，7.1%（n = 1729）有3次及以上TF。全因和偏头痛特异性HCU的调整年化率随TF次数增加而升高（高1.4 - 4倍；与1次TF相比，所有P均<0.0001）。与1次TF的患者相比，2次TF的患者平均全因医疗保健成本高出3732美元（95%置信区间[CI]：2708 - 4588美元），3次及以上TF的患者高出8912美元（95% CI：7141 - 10822美元）。门诊成本是医疗保健成本差异的主要驱动因素。
偏头痛患者的TF与大量资源和成本负担相关，且随TF次数增加而增加。
