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| 50th Annual Meeting of the American Headache Society |
Boston, Massachusetts June 26-29, 2008 |
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Tertiary headache care now pays off in Better
Health, Lower Costs Later |
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BY ALEC O’NEILL
Contributing Writer |
BOSTON — Third-party payers might be less
reluctant to open their wallets if they understood that
there is a high burden of disease among patients seen at
tertiary headache centers, and that the inpatient and
outpatient care offered at specialized centers can
ultimately reign in costs, investigators reported at the
50th Annual Meeting of the American Headache Society.
A study of the disease burden among 500 consecutive
patients to a tertiary headache clinic showed that
“tertiary referral headache centers are able to produce
substantial benefits in patients with longstanding
refractory headache in both disease impact parameters as
well as health care utilization in the first 6 months of
treatment,” reported Dr. Fred G. Freitag and colleagues
from the Diamond Headache Treatment Unit at St. Joseph
Hospital Resurrection Healthcare in Chicago, in a poster
presentation on June 27. (Freitag FG et al. Disease
Severity and Economic Impact of Headache in a Tertiary
Headache Treatment Center. Abstract F17.)
The authors set about developing measures of disease
burden and impact among patients with refractory
headache treated at their center.
They collected data on the burden of illness,
demographics, health care expenditures, Migraine
Disability Assessment Scale (MIDAS) scores, and health
care utilization in 500 consecutive new patients. In
all, 371 of the patients completed the first phase of
data collection and 294 completed a follow-up at 3–6
months after the initial visit and treatment as either
inpatients or in the outpatient clinic.
“The patient population demonstrated significant disease
impact,” the authors found. “The average patient is in
their mid 40’s with nearly 15 years of headaches. They
have nearly three secondary illnesses if they required
inpatient treatment, or two if they were outpatient.”
The average MIDAS score was 90, in the severe disability
range. Patients made an average of two doctors visits
per month for headache, and those who needed inpatient
treatment had an emergency department (ED) visit every
six weeks, compared with just one every three months for
outpatients.
One-fourth of all patients had been hospitalized within
the previous three months.
Patients who had initial inpatient therapy for migraine
had a history of more co-morbid illnesses than others,
more headache days, higher MIDAS scores, more physician
visits for headaches, more ED visits, and more
hospitalizations per 3-month periods. Not surprisingly,
those who were treated as inpatients tended to have
greater utilization of resources and more headaches of
greater severity than those were treated in ambulatory
setting.
“The most challenging group of patients is the group who
has chronic migraine without associated medication
overuse headache,” the authors wrote. “This represents a
rather heterogeneous population.”
Patients with chronic migraine, both with and without
medication overuse headaches, both benefited from
inpatient therapies, the authors noted, although the
greatest benefit was seen in those with medication
overuse headache.
Among patients in both groups, a comparison of
pre-treatment versus post-treatment 3-month costs showed
about a 4% decline in favor of therapy, substantial
decreases in doctor and emergency department visits, and
decreases in both MIDAS scores and headache days,
“The changes are robust for both inpatients as well as
outpatients,” the authors wrote in their conclusion.
“The overall effect of inpatient treatment produces
results that within 6 months bring patients to the same
level of disease impact and health care utilization
their outpatient counterparts had required or better.” |
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