Predictors of healthcare costs among patients with migraine in a commercial claims database

Objective: To assess predictors of direct costs among commercially-insured migraine patients. Background: The development of monoclonal antibodies against the Calcitonin Gene-Related Peptide or its receptor represents a significant advancement in migraine management. Lack of objective markers and heterogeneity make it difficult to assess patients who need migraine intervention. Design/Methods: This retrospective cohort study identified migraine patients in the Truven Health MarketScan Database from January 2008–June 2013. Patients were required to have 12 months enrollment pre/post evidence of migraine and no HIV or malignancy. Generalized linear models were used to identify predictors of increased costs and logistic regression was used to identify predictors of being in the top 25 th percentile of costs, controlling for baseline patient characteristics. Results: 857,073 patients met the inclusion criteria; mean age 43.2 years (SD=12.5); 83.2% female. Average annual all-cause costs were $13,045 (SD=$25,328), with the top 25 th percentile at $14,120. Opioid users (44%) had higher costs than non-users ($19,762 vs. $7,291); the odds of being in the top 25 th percentile was higher with 1–2 opioid claims (odds ratio [OR]=3.15), 3–6 claims (OR=5.1), or 7+ claims (OR=5.9) (all p th percentile. Conclusions: Migraine patients treated with migraine-specific or non-specific acute medications or migraine-related ER utilization have greater risk of being in the top 25 th percentile of total costs. These characteristics may be used to identify patients who could benefit from monitoring and care. Study Supported by: Amgen, Inc. Disclosure: Dr. Bonafede has received personal compensation for activities with Truven Health Analytics as an employee. Dr. Cai has received personal compensation for activities with Truven Health Analytics as an employee. Truven Healath Analytics was funded by Amgen to conduct this research. Dr. Cappell has received personal compensation for activities with Truven Health Analytics as an employee. Truven Health Analytics was paid by Amgen, Inc. to conduct this study. Dr. Kim has received personal compensation for activities with Amgen as a consultant. Dr. Sapra has received personal compensation for activities with Amgen as an employee. Se. Sapra holds stock and/or stock options in Amgen. Dr. Shah holds stock and/or stock options in Amgen which sponsored research in which Dr. Shah was involved as an investigator. Dr. Desai has received personal compensation for activities with Amgen Inc. as an employee. Dr. Desai hold stock and/or stock options in Amgen Inc. Dr. Winner has received personal compensation for activities with Avanir, Allergan, Teva, and Supernus. Dr. Winner has received personal compensation in an editorial capacity for Headache Currents and Journal Headache. Dr. Winner has received research support from Allergan, Amgen, A-Z, Teva, Pfizer, Novartis, and Lilly.