Poor Response to Triptans for Migraine Increases HCRU

Triptans are among the most commonly prescribed medication class for acute treatment for patients presenting with migraine attacks but researchers recently presented at the AAN 2020 Annual Meeting on the effects on health care resource utilization (HCRU) and costs for patients who experience insufficient response. 

Steven C Marcus, PhD, University of Pennsylvania and colleagues conducted a study with the goal of characterizing HCRU and costs for new triptan users in a commercially insured United States Population, noting that existing real-world observational studies have demonstrated low persistence.

The study cohort comprised adult patients with ≥1 triptan claim between January 1, 2013 and December 31, 2013 (first claim assigned as index date) and ≥12 months of pre-index and 24 months of post-index continuous enrollment from the Optum Clinformatics Data Mart claims database. To be included, patients were required to have had ≥1 migraine diagnosis but no prior triptan claims in the pre-index period.

Dr Marcus and colleagues examined migraine-related inpatient, outpatient, and emergency department (ED) visit frequencies, as well as associated costs. 

“Triptan users who refilled only triptan prescriptions were considered optimized; new users who did not refill their index triptan but used non-triptan acute treatments, or new users who continued using a triptan but supplemented it with non-triptan acute treatments for migraine, were considered not optimized (ie, potential triptan insufficient responders [TIRs]),” explained Dr Marcus and colleagues.

The patients who did not refill their index triptan or any other acute medication for migraine were not analyzed.

The final cohort included 10,509 new triptan users, of which 3102 (30%) were potential TIR patients. Looking at the subsequent 24-month period, potential TIR patients experience more migraine-related physician, inpatient, and ED visits and higher all-cause total costs, migraine-related total costs, and migraine-related medical costs (all P<0.05) than patients who continued using triptans.

“Adjusted total migraine-related costs were $2,905 higher in months 0-12 post-index and $2,615 higher in months 13-24 post-index for potential TIR patients than for those who continued using triptans (both P<0.05),” explained Dr Marcus and colleagues. 

“Patients with potentially insufficient response to triptans have higher healthcare resource utilization and higher migraine-related total costs than patients who are potentially optimized on triptans for acute treatment of migraine,” the researchers concluded. —Edan Stanley