Opioid Use, Economic Burdens of Migraine Detailed in Pair of Studies at ISPOR

What Is the Relationship Between Migraineurs’ Opioid Use and ED Visits?

Migraine is a disorder associated with high economic burden and poor quality of life that affects around 12% of the population, according to the Migraine Research Foundation. It is the 6^th most disabling illness in the world and disproportionately affects women. At the 2020 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) virtual conference, researchers presented data on treatment use, inpatient and outpatient visits, and pharmacy costs incurred by migraineurs.According to the American Headache Society (AHS), opioids continue to be used in over 50% of emergency department migraine visits and are often overprescribed to migraineurs. Researchers from the University of Texas set out to compare demographics, comorbidities, past opioid use, past preventive medication use, and past health resource utilization (HRU) among migraineurs who visited the emergency department (ED) and are users or non-users of opioids¹. In addition, investigators compared time to next migraine-related ED visit between those who used opioids and those who did not.

Electronic medical record (EMR) data from 788 enrollees in the Baylor Scott & White Health Plan were analyzed. Average participant age was 44.5 (SD14.6 years) and 85.9% of study participants were female. Around 36% of participants received opioids during their index ED visit (first migraine-related ED visit after >= 6 months of plan enrollment).

Researchers found that opioid users were more likely to have future migraine-related ED visits than non-opioid users.

Data showed that compared with non-opioid users, those who used opioids:

• Were more likely to have a diagnosis for sleep disorder (35.7% vs. 24.4%, P = .0007)
• Were more likely to have a diagnosis of anxiety (58.0% vs. 49.9%, P = .03)
• Had more past opioid use (median 5 vs. 2 prescriptions, P <.0001)
• Had more past hospitalizations (mean 0.82 vs. 0.58 visits, P <.0004)
• After controlling for covariates, had a significantly higher hazard ratio (HR) for future migraine-related ED visits (HR, 1.49)

Future migraine-related ED visits were also significantly associated with previous opioid use (HR, 2.12), previous ED visits (HR, 2.38), age (45-64 years HR, 0.68), gender (male HR, 0.55), tobacco use disorder (HR,1.45), and hypertension (HR, 1.46) (P <.05).

How Does Intensity of Treatment-Seeking Behavior Affect Costs for Migraineurs?

One explanation for this finding could be that opioid use carries a high risk of medication overuse headache (MOH), which may lead to patients seeking further treatment. “For many patients, overuse of opioids can trigger the transition from episodic migraine to chronic migraine,” the AHS states. “It is crucial to ensure that both simple analgesics and triptans are contraindicated before considering prescribing an opioid medication. These acute medications treat the source of the pain, not just the pain itself, and are less likely to induce migraine progression.”A separate abstract assessed all-cause annual inpatient (IP), outpatient (OP), and pharmacy health care costs associated with migraineurs who exhibited different intensities of treatment-seeking behavior². Researchers used IBM Market Scan to conduct a retrospective analysis of administrative claims in commercial and Medicare databases.

Data was collected from 338,584 adults between January 2016 through December 2017. Emergency room, physician, and hospital visits were considered outpatient care. Combinations of utilization OP and IP services and acute (ARx) and preventive (PRx) prescription migraine medications were used to stratify patients by intensity of treatment-seeking behavior.

Of the participants included, 82% were female while average age was 44 years old. Non-headache pain (64%), hypertension (26%) and anxiety (23%) were among the most commonly reported comorbidities.

Researchers found:

• Adjusted mean all-cause annual costs ranged from $6620 in OP-only cohort to $30,759 in OP+IP with/without (±) ARx cohort
• Adjusted mean all-cause inpatient costs ranged from $23,165 in OP-only to $44,182 in OP+IP±ARx cohorts
• Adjusted mean outpatient costs ranged from $4129 in OP-only to $16,086 in OP+IP±ARx cohorts
• Use of OP+ARx and/or OP+PRx was associated with increased outpatient costs from $5942 to $9,987 compared with OP-only
• Adjusted mean pharmacy costs ranged from $1596 in OP+ARx to $6861 in OP+IP±ARx cohorts

“Increases in intensity of treatment-seeking behavior, defined by use of migraine-specific medical and pharmacy services, were associated with incremental rises in annual healthcare expenditures, including inpatient, outpatient, and pharmacy costs,” investigators concluded. They suggest effective migraine prevention therapies may reduce treatment-seeking behavior, potentially mitigating associated economic migraine burden.

References:

1. Shao Q, Rascati K, Lawson K, et al. Opioid use among migraine patients at the emergency departments and subsequent migraine-related emergency department visits. Presented at: ISPOR 2020; May 18-20, 2020; Abstract PND114.
2. Horblyuk R, Tran O, Chan P et al. Annual inpatient, outpatient, and pharmacy costs associated with patients with migraine by intensity of treatment-seeking behavior. Presented at: ISPOR 2020; May 18-20, 2020; Abstract PND4.