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A Retrospective Matched Case–Control Study on Medical Costs of Refractory Migraine in T aiwan
Author(s) -
Tang ChaoHsiun,
Chen YongChen,
Ng Kwong,
Wang ShuuJiun
Publication year - 2013
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1111/head.12039
Subject(s) - migraine , medicine , medical costs , medical record , retrospective cohort study , case control study , residence , pediatrics , health care , demography , sociology , economics , economic growth
Background Migraine is associated with a significant economic burden in W estern countries. However, there is limited information regarding the impact of the cost of migraine in A sia. Objectives To quantify and compare the direct medical costs of refractory migraine ( RM ) and other migraine, using health insurance claims data in T aiwan. Methods A retrospective matched case–control study was conducted utilizing data from the T aiwan N ational H ealth I nsurance R esearch D atabase. RM cases were defined as patients with at least 1 neurological outpatient visit with a primary or secondary I nternational C lassification of D iseases, N inth R evision, C linical M odification code of 346.11 (common migraine with intractable migraine, so stated), diagnosed by certified neurologists in medical centers during 2007‐2008. The first control group was the non‐migraineurs matched with cases at a 4:1 ratio by age, gender, urbanization level of the residence, and income. The second control group was patients with other migraine types (346.00, 346.10, 346.20, 346.80, and 346.90) matched with cases at a 4:1 ratio by age, gender, and hospital setting. Medical utilization and costs within 365 days after the index visit date were assessed using a 2‐part model. The exchange rate for US $1 was NT $32.50. Results Patients with RM had significantly higher total medical costs compared with non‐migraineurs ( NT $57,932 [ US $1783] vs NT $26,817 [ US $825]; P < .001) or other migraineurs ( NT $54,678 [ US $1682] vs NT $38,397 [ US $1181]; P < .001). The mean drug costs for those with RM were also higher than for non‐migraineurs ( NT $19,752 [ US $608] vs NT $8660 [ US $266]; P < .001) or those with other migraine ( NT $17,623 [ US $542] vs NT $10,088 [ US $310]; P < .001). In addition, we reviewed the charts of all patients with an outpatient department diagnostic code of 346.11 (n = 98) at our hospital ( T aipei V eterans G eneral H ospital, a medical center in T aiwan) in 2007. Of these patients, 88 (90%) fulfilled the Silberstein– L ipton criteria for chronic migraine, ie, >15 headache days per month and presence of a history of migraine. Conclusions Refractory migraineurs in T aiwan had significantly higher medical costs than either non‐migraineurs or those with other migraine diagnoses.