title: Cost of health care among patients with chronic and episodic migraine in Canada and the USA: results from the International Burden of Migraine Study (IBMS).
abstract: OBJECTIVE
  To evaluate and compare healthcare resource use and related costs in chronic migraine and episodic migraine in the USA and Canada.
  
  
  BACKGROUND
  Migraine is a common neurological disorder that produces substantial disability for sufferers around the world. Several studies have quantified overall costs associated with migraine in general, with recent estimates ranging from $581 to $7089 per year. Although prior studies have characterized the clinical and humanistic burden of chronic migraine relative to episodic migraine, to the best of our knowledge only 1 previous study has compared chronic migraine and episodic migraine healthcare costs. The purpose of this study was to quantify and compare the direct medical costs of chronic migraine and episodic migraine using medical resource use data collected as part of the International Burden of Migraine Study.
  
  
  METHODS
  Cross-sectional data were collected from respondents in 10 countries via a Web-based survey. Respondents were classified as chronic migraine (≥15 headache days/month) or episodic migraine (<15 headache days/month). Data collection included socio-demographic and clinical characteristics and medical resource use for headache (clinician and emergency department visits and hospitalizations over the preceding 3 months and medications over the preceding 4 weeks). Unit cost data were collected outside of the Web-based survey using publicly available sources and then applied to resource use profiles. Cost estimates are presented in 2010 US and Canadian dollars.
  
  
  RESULTS
  In this manuscript, the analysis included data from respondents with migraine in the USA (N=1204) and Canada (N=681). The most common medical services utilized by all respondents included headache-specific medication, healthcare provider visits, emergency department visits, and diagnostic testing. In the USA, approximately one-quarter (26.2%) of chronic migraine participants vs 13.9% of episodic migraine participants reported visiting a primary care physician in the preceding 3 months (P<.001). In Canada, one-half (48.2%) of chronic migraine participants had a primary care physician visit, compared with 12.3% of episodic migraine subjects (P< .0001). Total mean headache-related costs for participants with chronic migraine in the USA were $1036 (±$1334) over 3 months compared to $383 (±807, P< .001) for persons with episodic migraine. In Canada, total mean headache-related costs among chronic migraine subjects were $471 (±1022) compared to $172 (±920, P< .001) for episodic migraine subjects.
  
  
  CONCLUSIONS
  Chronic migraine was associated with higher medical resource use and total costs compared to episodic migraine. Therapies that reduce headache frequency could become important approaches for containing or reducing headache-related medical costs.
authors.affiliation: United BioSource Corporation, 185 Dorval Avenue, Dorval, QC, Canada. michael.stokes@unitedbiosource.com
authors.forename: Michael
authors.initials: M
authors.lastname: Stokes
authors.forename: Werner J
authors.initials: WJ
authors.lastname: Becker
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Teresa K
authors.initials: TK
authors.lastname: Wilcox
authors.forename: Leandra
authors.initials: L
authors.lastname: Wells
authors.forename: Aubrey
authors.initials: A
authors.lastname: Manack
authors.forename: Irina
authors.initials: I
authors.lastname: Proskorovsky
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gladstone
authors.forename: Dawn C
authors.initials: DC
authors.lastname: Buse
authors.forename: Sepideh F
authors.initials: SF
authors.lastname: Varon
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Blumenfeld
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease; D017281:Cost of Illness; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology