Health care Resource Utilization and Migraine Disability Along the Migraine Continuum Among Patients Treated for Migraine
Health care Resource Utilization and Migraine Disability Along the Migraine Continuum Among Patients Treated for Migraine
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DOI：
10.1111/head.13421
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发表时间：
2018-11-01
期刊：
影响因子：
5
通讯作者：
Cohen, Joshua M.
中科院分区：
文献类型：
--
作者：
Silberstein, Stephen D.;Lee, Lulu;Cohen, Joshua M.
研究残疾，医疗资源利用，偏头痛患者的直接年度费用，分类根据头痛天数在过去month.Background-Migraine经历了一个连续的不同的攻击频率和相关的残疾水平。患有偏头痛的人增加了医疗保健的利用率，并且比没有这种疾病的人承担了更多的直接费用。虽然偏头痛的广泛影响是显而易见的，有必要全面描述头痛频率对疾病负担的影响。设计/方法数据从一个横断面，自我管理，基于互联网的调查，从美国国家卫生和健康调查小组招募的受访者进行了评估。在过去3个月内有自我报告的偏头痛诊断或偏头痛症状的成年人根据他们在过去一个月内头痛天数的频率进行分组：低频发作性偏头痛（LFEM，= 15天）。根据头痛影响测试（HIT-6）评分确定头痛相关残疾，并通过过去12个月内ER访视、住院和医疗保健从业者（HCP）访视次数评估医疗保健资源利用情况。根据2014年医疗支出调查的每种类型的就诊次数和全因成本数据计算估计的年度直接成本。结果共纳入1347例患者（LFEM，n = 813; MFEM，n = 301; HFEM，n = 105; CM，n = 128）。患者组之间的差异显着的共病指数，教育和收入水平，饮酒量，保险类型。总体而言，LFEM患者的残疾最少，医疗保健利用率和直接费用最低。CM患者评分为3.7分HIT-6组（校正后平均评分[95%置信区间，CI] 68.2 [67.3，69.0]分）高于LFEM组（64.5分[64.1，64.8]），而HFEM和MFEM的得分分别高出2.4（66.8分[65.9，67.8]）和2.3（66.7分[66.2，67.3]）分（所有，P <0.001）。CM和MFEM组报告的HCP访视显著更多（[平均值+/-标准误] CM：7.03 +/-0.83; MFEM：5.34 +/-0.42; vs LFEM：3.48 +/-0.18;均P <.001）和偏头痛相关住院（CM：0.06 +/-0.03; MFEM：0.05 +/-0.02; vs LFEM：0.02 +/-0.01;两者，P <0.05）。CM组和MFEM组与LFEM组相比，总直接成本有显著差异（CM：3155 +/-609美元; MFEM：2721 +/-342美元; vs LFEM：1560 +/-118美元;两者，P <0.001），差异主要由HCP访问的成本驱动。结论-在偏头痛患者中，随着头痛天数的增加，疾病负担（残疾、保健利用和直接费用）也是如此。阐明与EM和CM相关的负担对于指导偏头痛患者的治疗决策和管理具有重要意义。
Objective-To examine the disability, health care resource utilization, and direct annual costs among patients with migraine, categorized according to the number of headache days experienced in the past month.Background-Migraine exists on a continuum of different attack frequencies and associated levels of disability. People with migraine have increased health care utilization and incur substantially more direct costs than those without the disease. While the broad implications of migraine are evident, there is a need to comprehensively describe the impact of headache frequency on the burden of illness.Design/Methods-Data from a cross-sectional, self-administered, Internet-based survey of respondents recruited from the US National Health and Wellness Survey panel were assessed. Adults who had self-reported migraine diagnosis or migraine symptoms in the past 3 months were grouped by their frequency of headache days in the past month: low-frequency episodic migraine (LFEM, = 15 days). Headache-related disability was determined from the Headache Impact Test (HIT-6) scores, and health care resource utilization was assessed by the number of ER visits, hospitalizations, and visits to health care practitioners (HCPs) in the past 12 months. The estimated annual direct costs were calculated from the number of each type of visit and all-cause cost data from the 2014 Medical Expenditure Panel Survey.Results-A total of 1347 patients (LFEM, n = 813; MFEM, n = 301; HFEM, n = 105; CM, n = 128) were included. Patient groups differed significantly by comorbidity index, education and income level, alcohol consumption, and insurance type. Overall, patients with LFEM had the least disability and lowest health care utilization and direct costs. Patients with CM scored 3.7 points (adjusted mean score [95% confidence interval, CI] 68.2 [67.3, 69.0] points) higher on HIT-6 compared with those in the LFEM group (64.5 points [64.1, 64.8]), while those with HFEM and MFEM scored 2.4 (66.8 points [65.9, 67.8]) and 2.3 (66.7 points [66.2, 67.3]) points higher, respectively (all, P < .001). The CM and MFEM groups reported significantly more HCP visits ([mean +/- standard error] CM: 7.03 +/- 0.83; MFEM: 5.34 +/- 0.42; vs LFEM: 3.48 +/- 0.18; both, P < .001) and migraine-related hospitalizations (CM: 0.06 +/- 0.03; MFEM: 0.05 +/- 0.02; vs LFEM: 0.02 +/- 0.01; both, P < .05) than the LFEM group. There were significant differences in the total direct costs between the CM and MFEM groups compared with the LFEM group (CM: $3155 +/- $609; MFEM: $2721 +/- $342; vs LFEM: $1560 +/- $118; both, P < .001), with differences largely driven by costs of HCP visits.Conclusions-In patients with migraine, as the number of headache days increased, so did the burden of disease (disability, health care utilization, and direct costs). Elucidating the burden associated with EM and CM has implications for guiding treatment decisions and management of patients with migraine.