title: The economic impact of migraine: an analysis of direct and indirect costs.
abstract: OBJECTIVE
  This study examined whether individuals with migraine incurred greater direct and indirect costs than a matched group free of migraines.
  
  
  METHODS
  Using population-based survey data, we matched individuals with migraine (n = 1087) and a migraine-free control group one-to-one for age, sex, employment status, and number of comorbidities. We assessed the prior six months' direct medical care in terms of self-reported hospital days and emergency department and physician visits. Costs were computed by multiplying utilization by unit costs and summing across categories. Indirect costs were calculated based on the number of days missed from employment or household activities.
  
  
  RESULTS
  The sample was 80% female and had an average of 39 years and 0.4 comorbid conditions. Two-thirds were employed. Migraineurs had higher direct medical costs over the prior six months (522 dollars versus 415 dollars, P =.039), primarily due to a greater frequency of physician and emergency department visits. The cost of lost productivity for the migraine group was also higher, by more than 200 dollars (P =.014). The combined total for direct and indirect costs was 1,242 dollars for migraineurs and 929 dollars for the comparison group (P =.006). Additional analyses comparing those with moderate versus severe migraine demonstrated that more severe migraineurs had higher costs for lost productivity (1,021 dollars versus 251 dollars, P<.001) and higher costs when direct and indirect costs were combined (1,656 dollars versus 685 dollars, P<.001).
  
  
  CONCLUSIONS
  Migraine is an expensive illness and two-thirds of the financial burden is linked to indirect costs. Consequently, individuals with migraine, employers, and insurance companies all have an economic stake in reducing the migraine burden.
authors.affiliation: Sunnybrook and Women's Health Science Centre, The University of Toronto, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Edmeads
authors.forename: Joan A
authors.initials: JA
authors.lastname: Mackell
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D004526:Efficiency; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000191:economics*