title: Direct costs of preventive headache treatments: comparison of behavioral and pharmacologic approaches.
abstract: OBJECTIVE
  This study provides preliminary data and a framework to facilitate cost comparisons for pharmacologic vs behavioral approaches to headache prophylactic treatment.
  
  
  BACKGROUND
  There are few empirical demonstrations of cumulative costs for pharmacologic and behavioral headache treatments, and there are no direct comparisons of short- and long-range (5-year) costs for pharmacologic vs behavioral headache treatments.
  
  
  METHODS
  Two separate pilot surveys were distributed to a convenience sample of behavioral specialists and physicians identified from the membership of the American Headache Society. Costs of prototypical regimens for preventive pharmacologic treatment (PPT), clinic-based behavioral treatment (CBBT), minimal contact behavioral treatment (MCBT), and group behavioral treatment were assessed. Each survey addressed total cost accumulated during treatment (ie, intake, professional fees) excluding costs of acute medications. The total costs of preventive headache therapy by type of treatment were then evaluated and compared over time.
  
  
  RESULTS
  During the initial months of treatment, PPT with inexpensive mediations (<0.75 $/day) represents the least costly regimen and is comparable to MCBT in expense until 6 months. After 6 months, PPT is expected to become more costly, particularly when medication cost exceeds 0.75$ a day. When using an expensive medication (>3 $/day), preventive drug treatment becomes more expensive than CBBT after the first year. Long-term, and within year 1, MCBT was found to be the least costly approach to migraine prevention.
  
  
  CONCLUSIONS
  Through year 1 of treatment, inexpensive prophylactic medications (such as generically available beta-blocker or tricyclic antidepressant medications) and behavioral interventions utilizing limited delivery formats (MCBT) are the least costly of the empirically validated interventions. This analysis suggests that, relative to pharmacologic options, limited format behavioral interventions are cost-competitive in the early phases of treatment and become more cost-efficient as the years of treatment accrue.
authors.affiliation: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Schafer
authors.forename: Jeanetta C
authors.initials: JC
authors.lastname: Rains
authors.forename: Donald B
authors.initials: DB
authors.lastname: Penzien
authors.forename: Leanne
authors.initials: L
authors.lastname: Groban
authors.forename: Todd A
authors.initials: TA
authors.lastname: Smitherman
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Houle
mesh_terms: D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000191:economics*; D003365:Costs and Cost Analysis; D016527:Drug Costs; D006261:Headache / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D011060:Poloxalene / Q000494:pharmacology
chemical_list: D000700:Analgesics; D011060:Poloxalene