A study on the indirect costs of migraine in a large school district shows that the greatest costs are associated with absenteeism and productivity.
However, when examining the average benefit claims for an individual, including inpatient and outpatient costs and pharmacy costs, “migraine does not show up on the radar screen,” Wayne N. Burton, MD, FACOEM, FACP, continues, even though the condition “impacts an estimated 10% to 12% of the employee population compared with a disease like diabetes, which impacts approximately 5% of employees.”
One of the primary ways in which migraine impacts productivity is in absenteeism, Hines and Dr. Burton explain. Presenteeism, or decreased productivity at work, is another issue. Together, these two factors make up 93% of the cost of migraine, but the healthcare data available on these indirect costs—compared with direct costs, such as medications and ED visits—is limited.
For a study published in the Journal of Occupational and Environmental Medicine, Hines, Dr. Burton, and colleagues examined the demographics, health risks, pharmaceutical utilization, and other patient characteristics of adults with and without migraine who worked at a large, metropolitan school district.
Patient Demographics, Particularly Race, Impact Migraine Rates
The study cohort included 4,528 employees, 498 (11%) of whom self-reported experiencing migraine. Among the patients with migraine, nearly half (N=221; 44.4%) also self-reported taking medication for migraine. Individuals with migraine were significantly younger (40.3 vs 43.7), more often female (92.1% vs 78.0%), and more likely to be White (75.5% vs 69.9%) than employees without migraine. Those who reported taking medication for migraine were significantly older (41.9 vs 39.1), more often female (95.9% vs 89.4%), and more likely to be Black (21.9% vs 16.1%) compared with migraineurs who did not report taking medication. The researchers observed no significant differences among the groups regarding height, weight, or marital status.
The indirect costs of migraine identified in this study were also significant, according to Hines and Dr. Burton, and were mainly related to absenteeism and productivity (Table). Individuals with migraine used significantly more illness absence days (8.58) compared with employees without migraine (6.84). The total annual absence cost for an employee with migraine was calculated to be $3,576, compared to $2,937 for employees without migraine.
One of the biggest disparities was in the prevalence of Black patients with migraine taking medication, according to Hines and Dr. Burton. The finding that patients with migraine who were taking medication were significantly more likely to be Black (as well as female) stands in contrast to prior research, which demonstrated that Black patients with migraine were less likely to have a prescription for migraine compared with White patients.
“There is so much research about racial disparities in medicine,” Hines says. “The playing field was relatively equal here, as all participants were teachers, which removed some of the economic disparities or access to care issues that are often at play in racial disparities in healthcare.”
A potential explanation for this was the availability of on-site medical care for employees, according to the study results, and 48% of Black employees identified their worksite clinics as their main source of medical care.
“It’s likely that migraine is underdiagnosed in the Black community,” Dr. Burton says. “We need to continue to work to understand the factors leading to this underdiagnosis, including lack of access to care and community-based beliefs about mental health, which is a risk factor in migraine.”
Managing Medication Use for Patients With Migraine
“There are so many costs associated with migraine that are not medical,” Hines continues. “The patients who tended to do the best were those taking acute or preventive migraine medications.”
Underdiagnosis and misdiagnosis of migraine are important to consider, he continues, as migraine is underdiagnosed and misdiagnosed about 50% of the time. The use of opioids among patients with migraine in the study is another key point for clinicians.
“Patients taking opioids experienced nearly twice as many absent days lost,” Dr. Burton says. “There are far better medications for migraine than opioids. Physicians should be even more attuned to the use of opioids in this patient population.”