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Disability and Economic Costs

X. Henry Hu, MD, MPH, PhD; Leona E. Markson, ScD; Richard B. Lipton, MD; Walter F. Stewart, PhD, MPH; Marc L. Berger, MD

Arch Intern Med. 1999;159:813-818.

Background  Migraine is a common disabling disease but its economic burden has not been adequately quantified.

Objective  To estimate the burden of migraine in the United States with respect to disability and economic costs.

Methods  The following data sources were used: published data, the Baltimore County Migraine Study, MEDSTAT's MarketScan medical claims data set, and statistics from the Census Bureau and the Bureau of Labor Statistics. Disability was expressed as bedridden days. Charges for migraine-related treatment were used as direct cost inputs. The human capital approach was used in the estimation of indirect costs.

Results  Migraineurs required 3.8 bed rest days for men and 5.6 days for women each year, resulting in a total of 112 million bedridden days. Migraine costs American employers about $13 billion a year because of missed workdays and impaired work function; close to $8 billion was directly due to missed workdays. Patients of both sexes aged 30 to 49 years incurred higher indirect costs compared with younger or older employed patients. Annual direct medical costs for migraine care were about $1 billion and about $100 was spent per diagnosed patient. Physician office visits accounted for about 60% of all costs; in contrast, emergency department visits contributed less than 1% of the direct costs.

Conclusions  The economic burden of migraine predominantly falls on patients and their employers in the form of bedridden days and lost productivity. Various screening and treatment regimens should be evaluated to identify opportunities to reduce the disease burden.

From Outcomes Research and Management, US Human Health Division, Merck Co Inc, West Point, Pa (Drs Hu, Markson, and Berger); the Departments of Neurology, Epidemiology, and Social Medicine, Albert Einstein College of Medicine, New York, NY, (Dr Lipton); the Headache Unit, Montefiore Medical Center, Bronx, NY, (Dr Lipton); Innovative Medical Research, Stamford, Conn (Dr Lipton); and the Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University and Innovative Medical Research, Baltimore, Md (Dr Stewart).

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