Migraine Prophylaxis in Managed Care Organizations: Unclear Role in Disease Management Programs
Jennifer H. Lofland
Purna K. Lakhia
Migraine is a highly prevalent, chronic, episodic condition. The direct and indirect costs of migraine have a large economic impact. Research has shown that migraine abortive medications reduce healthcare costs, improve health-related quality of life, decrease migraine disability and keep patients effective in the workplace. This class of medications, therefore, has a clearly defined role within a disease management program. However, the role of prophylactic medications in terms of costs and patient-focused outcomes within a disease management program has not been clearly defined. Based on a review of the US Headache Consortium Evidence-Based Treatment Guidelines and an examination of issues surrounding prophylactic medications, we conclude that the role of preventive therapy in terms of costs and patient-focused outcomes is not clearly defined. Currently, there are insufficient data available to assess the impact of migraine prophylactic therapy on costs and patient-focused outcomes. Hence, it is premature to state the precise role of preventive therapy in a migraine disease management program. Additional research is needed to better delineate the criteria for migraine prophylaxis, to validate clinical efficacy studies of preventive therapy, to determine the cost-effectiveness of prophylactic therapy, and to determine the effect of preventive therapy on patients' health resource use, health-related quality of life, and lost productivity.
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