title: Humanistic and economic burden of nausea and vomiting among migraine sufferers.
abstract: BACKGROUND
  While studies have demonstrated the economic burden of migraines in terms of quality of life, health care resource use (HRU), and costs, there exists a notable paucity of data comparing such outcomes among migraineurs with nausea and vomiting (N/V) and those without. The current study aimed to address this gap.
  
  
  METHODS
  This was a retrospective study using data from the 2013 US National Health and Wellness Survey, a cross-sectional, internet-based survey. Respondents self-reported their migraine with or without N/V along with demographics and outcomes including depression (Patient Health Questionnaire total score; PHQ-9), sleep problems (11-item total score of sleep problems), HRU (number of physician visits, emergency room [ER] visits, and hospitalizations) and Work Productivity and Activity Impairment-General Health Scale (WPAI-GH), and associated mean annual costs. Generalized linear models, adjusting for covariates, assessed the burden of N/V on all outcomes.
  
  
  RESULTS
  Among all migraineurs (N=7,855), 73.4% were female, mean age was 41.82 years old, and 57.6% reported experiencing N/V. Adjusting for covariates, migraineurs with N/V vs without N/V had higher mean PHQ-9 scores (7.91 vs 7.02,p<0.001) and mean sleep problems (3.29 vs 2.64,p<0.001). Mean ER visits were more frequent among migraineurs with N/V than those without N/V (0.48 vs 0.38,p=0.001). This difference translated into a 26.3% increase in estimated mean ER costs (N/V=US$1,499 vs without N/V=US$1,187,p=0.002). Mean percentage activity impairment was higher in migraineurs with N/V than in those without N/V (37.73% vs 35.12%,p=0.002) and migraineurs with N/V had higher work productivity loss costs (N/V=US$10,344 vs without N/V=US$9,218,p=0.016).
  
  
  CONCLUSIONS
  Migraine patients with N/V reported worse depression, sleep problems, and activity impairment, and higher ER visits than those without N/V. Migraine with N/V was also associated with an increase in mean annual ER visit costs and work productivity loss costs. Study findings suggest unmet needs with current treatment options for migraine patients with N/V.
authors.affiliation: Global Health Economics Research, Teva Pharmaceuticals, New York, NY, USA.
authors.forename: Kavita
authors.initials: K
authors.lastname: Gajria
authors.affiliation: Health Outcomes Practice, Kantar Health, Foster City, CA, USA.
authors.forename: Lulu K
authors.initials: LK
authors.lastname: Lee
authors.affiliation: Health Outcomes Practice, Kantar Health, Foster City, CA, USA.
authors.forename: Natalia M
authors.initials: NM
authors.lastname: Flores
authors.affiliation: Global Health Economics Research, Teva Pharmaceuticals, New York, NY, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Aycardi
authors.affiliation: Global Health Economics Research, Teva Pharmaceuticals, New York, NY, USA.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Gandhi
keywords: costs; depression; healthcare resource use; migraine; nausea; vomiting; work productivity