(356) Evaluation of unmet needs and quality-of-care indicators among patients with migraine in the United States: 2021–2022

Background: : Migraine is a common, debilitating headache disorder with substantial unmet need despite recent therapeutic advances.

Objective: : Assess unmet needs and gaps in migraine care by evaluating demographics, frequency, healthcare resource utilization (HRU), and medication use as quality of care (QOC) indicators.

Methods: : Using 2021-2022 Merative® MarketScan claims, adults with continuous enrollment were evaluated. The frequency of episodic, chronic and overall migraine (EM or CM) was assessed using ICD-10 diagnosis codes. Migraine QOC indicators included: (1)migraine-related healthcare visits: ED, urgent care, neurology, primary care, outpatient, inpatient hospitalizations, 30-day hospital readmission; (2)medication use: acute (generic [triptans, opioids, NSAIDs, etc.] and branded [Ubrogepant, Zavegepant, etc.]) and preventive (oral migraine preventive medications[anticonvulsants, antidepressants, antihypertensives, and other combination medications] and branded [CGRP mAbs, Botox, Atogepant, etc.]); (3)other migraine-related diagnoses: acute medication overuse (AMO) and medication overuse headache (MOH) for drug-induced headache; and (4)other migraine-related HRU: MRI and CT.

Results: : In 2021 and 2022, 356,395 and 360,182 patients were identified; 83% had EM, 17% CM. Most had outpatient visits (97%, mean[SD]: 2.3[3.0]) and < 3% of patients had ≥1 migraine-related hospitalization or urgent care visit, AMO, or MOH. 21% had neurology visits (mean[SD]: 0.46[1.2]), and more than half had migraine-related primary care visits (2021: 53%, mean[SD]: 0.9[1.3]; 2022: 51%, mean[SD]: 0.8[1.3]). 7% had ≥1 migraine-related ED visits. The 30-day readmission rate was 4%. Generic treatment use (69% & 65% for acute; 59% & 57% for preventive) was higher than branded therapies for 2021 and 2022, respectively. From 2021 to 2022, generic acute treatments declined from 69% (mean[SD]: 3.3 prescriptions[5.0]) to 65% (mean[SD]: 3.1 prescriptions[4.8]), branded acute treatments slightly increased from 8% (mean[SD]: 0.3[1.4]) to 10% (mean[SD]: 0.4[1.6]). Generic oral migraine preventive treatment slightly decreased from 59% (mean[SD]: 4.1 prescriptions[5.6]) to 57% (mean[SD]: 4.0 prescriptions[5.5]), branded preventive treatment increased from 5% (mean[SD]: 0.2[0.8]) to 8% (mean[SD]: 0.3[1.3]). A slight reduction in barbiturate and opioid use was observed in 2022, with a ~1 in 4 patients reporting an opioid fill (26% in 2021; 24% in 2022).

Conclusions: : HRU patterns for outpatient, primary care, neurology, and ED visits, along with acute and preventive medication use reveal gaps and unmet needs in migraine management strategies.

Sponsorship:: AbbVie