Abstract：
OBJECTIVE: To describe treatment patterns and direct healthcare costs over 3 years following initiation of standard of care acute and preventive migraine medications in patients with migraine in the United States.
BACKGROUND: There are limited data on long-term (>1 year) migraine treatments patterns and associated outcomes.
METHODS: This was a retrospective, observational cohort study using US claims data from the IBM® MarketScan® Research Database (January 2010-December 2017). Adults were included if they had a prescription claim for acute migraine treatments (AMT) or preventive migraine treatments (PMT) in the index period (January 2011-December 2014). The AMT cohort was categorized as persistent, cycled, or added-on subgroups; the PMT cohort was categorized PMT-persistent, switched without gaps, or cycled with gaps. Migraine-specific annual direct costs (2017 US$) across AMT and PMT cohort subgroups were summarized at baseline through 3 years from index (follow-up).
RESULTS: During the index period, 20,778 and 42,259 patients initiated an AMT and a PMT, respectively. At the 3-year follow-up, migraine-specific direct costs were lower in the persistent subgroup relative to the non-persistent subgroups in both AMT (mean [SD]: $789 [$1741] vs. $2847 [$8149] in the added-on subgroup and $862 [$5426] for the cycled subgroup) and PMT cohorts (mean [SD]: $1817 [$5892] in the persistent subgroup vs. $4257 [$11,392] in the switched without gaps subgroup and $3269 [$18,540] in the cycled with gaps subgroup). Acute medication overuse was lower in the persistent subgroup (1025/6504 [27.2%]) vs. non-persistent subgroups (11,236/58,863 [32.2%] in cycled with gaps subgroup and 1431/6504 [39.4%] in the switched without gaps subgroup). Most patients used multiple acute (19,717/20,778 [94.9%]) or preventive (38,494/42,259 [91.1%]) pharmacological therapies over 3 years following treatment initiation. Gaps in preventive therapy were common; an average gap ranged from 85 to 211 days (~3-7 months).
CONCLUSIONS: Migraine-specific annual healthcare costs and acute migraine medication overuse remained lowest among patients with persistent AMT and PMT versus non-persistent treatment. Study findings are limited to the US population. Future studies should compare costs and associated outcomes between newer preventive migraine medications in patients with migraine.
BACKGROUND: There are limited data on long-term (>1 year) migraine treatments patterns and associated outcomes.
METHODS: This was a retrospective, observational cohort study using US claims data from the IBM® MarketScan® Research Database (January 2010-December 2017). Adults were included if they had a prescription claim for acute migraine treatments (AMT) or preventive migraine treatments (PMT) in the index period (January 2011-December 2014). The AMT cohort was categorized as persistent, cycled, or added-on subgroups; the PMT cohort was categorized PMT-persistent, switched without gaps, or cycled with gaps. Migraine-specific annual direct costs (2017 US$) across AMT and PMT cohort subgroups were summarized at baseline through 3 years from index (follow-up).
RESULTS: During the index period, 20,778 and 42,259 patients initiated an AMT and a PMT, respectively. At the 3-year follow-up, migraine-specific direct costs were lower in the persistent subgroup relative to the non-persistent subgroups in both AMT (mean [SD]: $789 [$1741] vs. $2847 [$8149] in the added-on subgroup and $862 [$5426] for the cycled subgroup) and PMT cohorts (mean [SD]: $1817 [$5892] in the persistent subgroup vs. $4257 [$11,392] in the switched without gaps subgroup and $3269 [$18,540] in the cycled with gaps subgroup). Acute medication overuse was lower in the persistent subgroup (1025/6504 [27.2%]) vs. non-persistent subgroups (11,236/58,863 [32.2%] in cycled with gaps subgroup and 1431/6504 [39.4%] in the switched without gaps subgroup). Most patients used multiple acute (19,717/20,778 [94.9%]) or preventive (38,494/42,259 [91.1%]) pharmacological therapies over 3 years following treatment initiation. Gaps in preventive therapy were common; an average gap ranged from 85 to 211 days (~3-7 months).
CONCLUSIONS: Migraine-specific annual healthcare costs and acute migraine medication overuse remained lowest among patients with persistent AMT and PMT versus non-persistent treatment. Study findings are limited to the US population. Future studies should compare costs and associated outcomes between newer preventive migraine medications in patients with migraine.
摘要：
目的：描述美国偏头痛患者开始治疗急性和预防性治疗药物标准后3年的治疗模式和直接医疗费用。
背景：关于长期（>1年）偏头痛治疗模式和相关结局的数据有限。
方法：这是一个回顾性研究，使用IBM®MarketScan®研究数据库(2010年1月至2017年12月)的美国索赔数据进行的观察性队列研究.如果成年人在指数期（2011年1月至2014年12月）有急性偏头痛治疗（AMT）或预防性偏头痛治疗（PMT）的处方要求，则包括在内。AMT队列被归类为持久性，骑自行车,或附加亚组；PMT队列被归类为PMT-持久性，无间隙切换，或与间隙循环。AMT和PMT队列亚组的偏头痛特异性年度直接费用（2017美元）在基线至3年（随访）进行了总结。
结果：在索引期间，20,778和42,259名患者开始了AMT和PMT，分别。在3年的随访中，在两个AMT中，相对于非持续性亚组，持续性亚组的偏头痛特异性直接成本较低（平均值[SD]：$789[$1741]vs.附加子组中为$2847[$8149]，循环子组中为$862[$5426]）和PMT队列（持久性子组中的平均值[SD]：$1817[$5892]与无间隙子组中的$4257[$11,392]和带间隙子组中的$3269[$18,540])。急性药物过度使用在持续性亚组（1025/6504[27.2%]）和非持久性亚组(11,236/58,863[32.2%]在有间隙的循环亚组和1431/6504[39.4%]在无间隙的切换亚组)。大多数患者在治疗开始后3年内使用多种急性（19,717/20,778[94.9%]）或预防性（38,494/42,259[91.1%]）药物治疗。预防性治疗的差距很常见；平均差距为85至211天（〜3-7个月）。
结论：在AMT和PMT持续治疗的患者中，偏头痛特异性年度医疗费用和急性偏头痛药物过度使用仍然最低。研究结果仅限于美国人口。未来的研究应该比较偏头痛患者的新型预防性偏头痛药物的成本和相关结果。
背景：关于长期（>1年）偏头痛治疗模式和相关结局的数据有限。
方法：这是一个回顾性研究，使用IBM®MarketScan®研究数据库(2010年1月至2017年12月)的美国索赔数据进行的观察性队列研究.如果成年人在指数期（2011年1月至2014年12月）有急性偏头痛治疗（AMT）或预防性偏头痛治疗（PMT）的处方要求，则包括在内。AMT队列被归类为持久性，骑自行车,或附加亚组；PMT队列被归类为PMT-持久性，无间隙切换，或与间隙循环。AMT和PMT队列亚组的偏头痛特异性年度直接费用（2017美元）在基线至3年（随访）进行了总结。
结果：在索引期间，20,778和42,259名患者开始了AMT和PMT，分别。在3年的随访中，在两个AMT中，相对于非持续性亚组，持续性亚组的偏头痛特异性直接成本较低（平均值[SD]：$789[$1741]vs.附加子组中为$2847[$8149]，循环子组中为$862[$5426]）和PMT队列（持久性子组中的平均值[SD]：$1817[$5892]与无间隙子组中的$4257[$11,392]和带间隙子组中的$3269[$18,540])。急性药物过度使用在持续性亚组（1025/6504[27.2%]）和非持久性亚组(11,236/58,863[32.2%]在有间隙的循环亚组和1431/6504[39.4%]在无间隙的切换亚组)。大多数患者在治疗开始后3年内使用多种急性（19,717/20,778[94.9%]）或预防性（38,494/42,259[91.1%]）药物治疗。预防性治疗的差距很常见；平均差距为85至211天（〜3-7个月）。
结论：在AMT和PMT持续治疗的患者中，偏头痛特异性年度医疗费用和急性偏头痛药物过度使用仍然最低。研究结果仅限于美国人口。未来的研究应该比较偏头痛患者的新型预防性偏头痛药物的成本和相关结果。
