(132) Health care resource utilization and economic burden in patients cycling through multiple triptans for migraines: a retrospective analysis

Background: : Poor efficacy and tolerability to triptans may result in increased use of other acute and preventive migraine treatments, HCRU, and costs.

Objective: : Determine the triptan cycling burden by comparing medication use, MOH diagnoses, and migraine-specific HCRU and costs in patients treated with a single triptan versus two or more triptans.

Methods: : This retrospective claims analysis used the MarketScan Databases (January 1, 2015-February 28, 2023). Patients ≥18yrs old with migraines and ≥1 prescription claim for a triptan ≥January 1st, 2016 were divided into 2 cohorts: those continuing the same triptan (index fill with ≥1 refill; 1 triptan cohort) and those who used 2 or more different triptans (≥1 fill for index triptan and ≥1 fill for a different triptan; 2+ triptans cohort) over a 24-month follow-up period. The index date was the earliest claim. To ensure that only new triptan users were included, patients with any claims for a triptan during the 12 months pre-index were excluded. Descriptive statistics summarized baseline demographics and clinical characteristics. Comparisons of post-index medication use were made using chi-square tests. Regression models evaluated MOH and adjusted migraine-specific HCRU and costs over a 24-month follow-up period.

Results: : Of 184,717 new triptan users, 91,406 (49.5%) were in the 1 triptan and 22,909 (12.4%) were in the 2+ triptans cohort. In the 1 triptan cohort, 32.1% had 1 refill, 18.1% had 2 refills, and 49.8% had ≥3 refills of their index triptan. Patient demographics and clinical characteristics were similar in both cohorts. Mean age was 42yrs for the 1 triptan and 38yrs for the 2+ triptans cohort. Most patients were female (1 triptan, 82.2%; 2+ triptans, 85.9%). Most had episodic migraines (1 triptan, 94.9%; 2+ triptans, 92.0%). Migraine-related acute treatment use excluding triptans (48.8% vs 29.6%) and preventive treatment use (83.1% vs 68.9%) were higher in the 2+ triptans cohort (all P < .001). Diagnosed MOH occurred in 3.5% and 1.1% of the 2+ and 1 triptan cohorts, respectively (odds ratio, 2.98 [95% CI, 2.71-3.28]). Migraine-related ER, diagnostic imaging, and outpatient visits were 1.4, 1.3, and 1.4x higher in the 2+ triptans cohort. Adjusted migraine-related medical costs were $2,235 higher (mean ratio, 1.88 [95% CI, 1.79-1.98]) and prescription costs were $1,939 higher (mean ratio, 2.31 [95% CI, 2.23-2.41]) in the 2+ triptans cohort.

Conclusions: : Cycling through ≥ 2 triptans was associated with higher use, more MOH diagnoses, more ER visits, more diagnostic imaging, more outpatient visits, and higher medical and prescription costs.

Sponsorship:: AbbVie