Costs and Utilization of Triptan Users Who Receive Drug Prophylaxis for Migraine Versus Triptan Users Who Do Not Receive Drug Prophylaxis

OBJECTIVES: The objectives were 2-fold: (1) to describe the utilization patterns of new users of triptan therapy and (2) to measure the direct (pharmacy and medical) costs of migraine-related health care services in moderate-to-severe migraine patients treated with drug prophylaxis compared with migraine patients who are not treated with drug prophylaxis. METHODS: A retrospective administrative database study was conducted from the perspective of a managed care health plan. Patients initiating triptan therapy were identified, and utilization in the 12 months following initiation of drug therapy was determined. In addition, moderate-to-severe migraine patients were identified based on the quantity of triptan medication dispensed. Patients were classified as utilizing or not utilizing migraine prophylaxis. Migraine-specific health services costs in the 12 months following identification were determined. A multivariate ordinary least squares regression model was constructed to determine the impact of the use of drug prophylaxis on total cost. Utilizing the model, the difference in health services costs was predicted for each subject and the average treatment effect was computed. RESULTS: Thirty-nine percent of new triptan users received only 1 triptan claim during the 12-month follow-up period, accounting for 11.5% of the total triptan cost incurred by the health plan for this cohort. For new triptan users, triptan use in the first or second quarter was correlated with triptan use in the entire 12-month follow-up period (r=0.187 and 0.279, respectively). The mean migraine related pharmacy cost per patient during the follow-up was $871; however, continuous users had mean costs ($1,505) nearly 3 times the mean costs for new users ($506, P less than 0.05). The average treatment effect of drug prophylaxis in moderate-to-severe migraine patients was a decrease of $560 ($514-$607) per patient per year in 1998-2001 dollars. CONCLUSIONS: High utilizers of migraine therapy can be identified early in treatment. Drug prophylaxis for migraine is cost saving, and an intervention program that increases the use of migraine prophylaxis in potential candidates could be cost beneficial.