Health Care Resource Utilization Following Initiation of a Triptan: A Retrospective Claims Analysis

BACKGROUND: 23 million Americans suffer from migraine headaches, incurring more than $1 billion in direct medical costs each year (with another $13 billion in indirect productivity losses). Triptans are the most common treatment of choice for these patients; however, adherence and persistence to triptans are poor. Partly due to poor adherence to therapy, the ability of triptans to reduce the utilization of other medical services and prescription drugs remains unclear. OBJECTIVES: To (a) assess changes in the utilization of medical services and relevant prescription drugs after patients suffering from episodic migraines begin triptan therapy and (b) further investigate the relationship between concomitant opioid use among triptan-treated migraine patients and further utilization of medical services and prescription drugs. METHODS: A retrospective analysis of pharmacy and medical insurance claims was carried out using a large and nationally representative database. The utilization patterns of episodic migraine patients were observed for 12 to 24 months prior to their first triptan prescription and 12 to 24 months following that prescription. Resource utilization included physician office visits, diagnostic imaging, emergency room use, inpatient hospitalization, opioid prescriptions, migraine prophylaxis prescriptions, and acetaminophen or nonsteroidal anti-inflammatory prescriptions. Results were stratified according to triptan-switching behavior. RESULTS: The analytic sample included 9,521 migraine patients who were followed for a median of 550 days before and after their first triptan fill. 40.9% of these patients filled their triptan prescriptions only once (index fill). Another 40.3% filled a triptan prescription at least twice and never switched their triptan brand. 15.6% of patients switched their triptan prescriptions once, and 3.2% of patients switched their triptan prescriptions twice or more. The only group to display significant reductions in resource utilization following the prescription of a triptan was the cohort that never refilled the medication, potentially suggestive of misdiagnosis. Either no significant change or a significant increase in resource utilization was seen in all other cases. The ability of triptans to reduce resource utilization seemed to be lower among patients who switched triptans more often. Patients that concomitantly used opioid medications in addition to triptans also used significantly more resources than migraine patients who were not treated with opioids. CONCLUSIONS: Contrary to the findings of some previous research, the initiation of triptan therapy did not significantly reduce the utilization of migraine-related medical services or other relevant prescription drugs in this retrospective claims analysis. This may have been due to higher and more realistic rates of triptan switching and discontinuation. Consistent with previous findings, patients using concomitant opioids used more migraine-related health care resources.