Wang Yen-Feng, Wang Shuu-Jiun, Huang Yao Hsien, Chen Yung-Tai, Yen Yu-Chun, Shia Ben-Chang, Tsai Ching-Wen, Chan Hoi-Fong, Panni Tommaso, Dell'Agnello Grazia
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Front Neurol. 2023 Aug 16;14:1222912. doi: 10.3389/fneur.2023.1222912. eCollection 2023.
Given the substantial disease burden, appropriate and effective management of migraine is a public health priority. To gain insights into real-world migraine management practices in Taiwan, current treatment patterns, costs, and health care resource use were assessed.
This was a retrospective, longitudinal study using the Taiwan National Health Insurance Research Database. Included patients had an initial diagnosis of migraine (defined using International Classification of Diseases codes) between 1 January 2013 and 31 December 2017. Data analyzed included demographics; the use, number, and type of acute and preventive medications; and drug and medical services costs. Data were stratified according to migraine type (chronic [CM] or episodic [EM] migraine).
A total of 312,718 patients were included in the analyses: 53,992 (17.3%) had CM and 258,726 (82.7%) had EM. Most patients (81.7%) had used acute and/or preventive medications; acute medications used more frequently than preventive medications (78.0% vs. 20.2%). Acute medications were used by 81.6 and 77.3% of patients with CM and EM, respectively. Commonly used acute medications were acetaminophen (68.8%), ergots (49.4%), and non-steroidal anti-inflammatory drugs (38.4%); the use of triptans (6.0%), tramadol (3.1%), and other opioids (0.2%) was less common. A total of 28.6 and 18.5% of patients with CM and EM, respectively, used preventive medications. Flunarizine (68.9%), propranolol (40.7%), and topiramate (16.0%) were the most commonly used preventive medications. Most patients had used 1-2 acute or preventive medications, with the use of ≥3 acute or preventive medications more common in patients with CM than EM. Average total medical cost was 4,169 New Taiwan Dollars (NTDs) per CM patient and 2,928 NTDs per EM patient, with CM patients having higher costs associated with medical service utilization and acute medication use.
These real-world data suggest unmet needs for Taiwanese patients with migraine, including under-utilization of preventive medications and greater costs and health care resource use for patients with CM versus EM. These findings provide important information on treatment patterns, cost, and health care resource use for patients with migraine in Taiwan.
鉴于偏头痛带来的巨大疾病负担，对其进行恰当有效的管理是公共卫生的重点。为深入了解台湾地区偏头痛的实际管理情况，对当前的治疗模式、成本及医疗资源使用情况进行了评估。
这是一项利用台湾全民健康保险研究数据库开展的回顾性纵向研究。纳入的患者在2013年1月1日至2017年12月31日期间首次被诊断为偏头痛（依据国际疾病分类代码定义）。分析的数据包括人口统计学信息、急性和预防性药物的使用情况、数量及类型，以及药物和医疗服务成本。数据按偏头痛类型（慢性偏头痛[CM]或发作性偏头痛[EM]）进行分层。
总计312,718例患者纳入分析，其中53,992例（17.3%）为慢性偏头痛患者，258,726例（82.7%）为发作性偏头痛患者。大多数患者（81.7%）使用过急性和/或预防性药物；急性药物的使用频率高于预防性药物（78.0%对20.2%）。慢性偏头痛和发作性偏头痛患者中分别有81.6%和77.3%使用过急性药物。常用的急性药物有对乙酰氨基酚（68.8%）、麦角制剂（49.4%）和非甾体抗炎药（38.4%）；曲坦类药物（6.0%）、曲马多（3.1%）和其他阿片类药物（0.2%）的使用较少见。慢性偏头痛和发作性偏头痛患者中分别有28.6%和18.5%使用过预防性药物。氟桂利嗪（68.9%）、普萘洛尔（40.7%）和托吡酯（16.0%）是最常用的预防性药物。大多数患者使用过1 - 2种急性或预防性药物，慢性偏头痛患者使用≥3种急性或预防性药物的情况比发作性偏头痛患者更常见。慢性偏头痛患者的平均总医疗费用为每人新台币4,169元，发作性偏头痛患者为每人新台币2,928元，慢性偏头痛患者在医疗服务利用和急性药物使用方面的成本更高。
这些真实世界数据表明台湾偏头痛患者存在未被满足的需求，包括预防性药物使用不足，以及慢性偏头痛患者与发作性偏头痛患者相比成本更高、医疗资源使用更多。这些发现为台湾偏头痛患者的治疗模式、成本及医疗资源使用提供了重要信息。
