title: Real-world economic impact of onabotulinumtoxinA in patients with chronic migraine.
abstract: OBJECTIVE
  To determine whether the utilization of healthcare resources is reduced after chronic migraine patients are treated for 6 months with onabotulinumtoxinA.
  
  
  BACKGROUND
  OnabotulinumtoxinA is indicated for headache prophylaxis in patients with chronic migraine, but its effect on healthcare resource use is unknown.
  
  
  METHODS
  We analyzed data from an open-label study of 230 chronic migraine patients refractory to ≥2 oral prophylactics who presented to a headache specialty clinic and who were treated with two cycles of onabotulinumtoxinA. Frequency and cost of migraine-related healthcare resource use, including visits to emergency departments, urgent care, or hospitalization, were compared for the 6 months before and after initial treatment. Costs were based on publicly available sources.
  
  
  RESULTS
  Compared with the 6 months predating initial treatment, patients had 55% fewer emergency department visits (174 vs 385), 59% fewer urgent care visits (61 vs 150), and 57% fewer hospitalizations (19 vs 45) during the 6-month treatment period (P < .01 for all). Analysis of treatment-related costs yielded an average reduction of $1219.33/patient, off-setting 49.7% of the total estimated cost for 6 months of treatment with onabotulinumtoxinA.
  
  
  CONCLUSIONS
  Although we are unable to distinguish onabotulinumtoxinA's treatment effect from other potential confounding variables, our analysis showed that severely afflicted, treatment-refractory patients with chronic migraine experienced a significant cost-offset through reduced migraine-related emergency department visits, urgent care visits, and hospitalizations in the 6 months following treatment initiation of onabotulinumtoxinA. Future analyses will assess the longer-term effect of onabotulinumtoxinA treatment and the potential contribution of regression to the mean.
authors.affiliation: Department of Neurology, Renown Neurosciences Institute, Reno, NV, USA; Division of Neurosciences, University of Nevada/Reno School of Medicine, Reno, NV, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Rothrock
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bloudek
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Houle
authors.forename: Diane
authors.initials: D
authors.lastname: Andress-Rothrock
authors.forename: Sepideh F
authors.initials: SF
authors.lastname: Varon
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000191:economics* / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: chronic migraine; cost-offset; healthcare resource use; onabotulinumtoxinA; prophylaxis