title: Comparative effectiveness of onabotulinumtoxinA versus oral migraine prophylactic medications on headache-related resource utilization in the management of chronic migraine: Retrospective analysis of a US-based insurance claims database.
abstract: BACKGROUND
  Migraine, especially chronic migraine (CM), causes substantial disability; however, health care utilization has not been well characterized among patients receiving different migraine prophylactic treatments.
  
  
  METHODS
  Using a large, US-based, health care claims database, headache-related health care utilization was evaluated among adults with CM treated with onabotulinumtoxinA or oral migraine prophylactic medications (OMPMs). Headache-related health care utilization was assessed at six, nine, and 12 months pre- and post-treatment. The primary endpoint was the difference between pre- and post-index headache-related health care utilization. A logistic regression model was created to test the difference between onabotulinumtoxinA and OMPM-treated groups for headache-related emergency department (ED) visits and hospitalizations.
  
  
  RESULTS
  Baseline characteristics were comparable between groups. The proportion of patients with ED visits or hospitalizations for a headache-related event decreased after starting onabotulinumtoxinA, but increased after starting an OMPM, for all three cohorts. Regression analyses showed that the odds of having a headache-related ED visit were 21%, 20%, and 19% lower and hospitalization were 47%, 48%, and 56% lower for the onabotulinumtoxinA group compared to the OMPM group for the six-month, nine-month, and 12-month post-index periods, respectively.
  
  
  CONCLUSIONS
  When compared with similar patients who initiated treatment with OMPM, onabotulinumtoxinA was associated with a significantly lower likelihood of headache-related ED visits and hospitalizations.
authors.affiliation: Global Health Economics and Outcomes Research, Allergan plc, USA Hepp_Zsolt@Allergan.com.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Hepp
authors.affiliation: Headache Center, Hofstra Northshore LIJ, USA.
authors.forename: Noah L
authors.initials: NL
authors.lastname: Rosen
authors.affiliation: Global Health Economics and Outcomes Research, Allergan plc, USA.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Gillard
authors.affiliation: Global Health Economics and Outcomes Research, Allergan plc, USA.
authors.forename: Sepideh F
authors.initials: SF
authors.lastname: Varon
authors.affiliation: Consultant to Allergan plc., USA.
authors.forename: Nitya
authors.initials: N
authors.lastname: Mathew
authors.affiliation: Department of Neurology, Mayo Clinic, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Dodick
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000517:prevention & control*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D000700:Analgesics; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Chronic migraine; claims database; emergency department visits; hospitalizations; office visits; onabotulinumtoxinA; out-of-pocket expenses; payer costs; resource utilization