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Real-World Health Plan Claims Analysis of Differences in Healthcare Utilization and Total Cost in Patients Suffering From Cluster Headaches and Those Without Headache-Related Conditions
Michael Polson, MS, PharmD; Todd C. Lord, PharmD; Themmi M. Evangelatos, PharmD, MSBA; Maria Lopes, MD; and Briana L. Santaniello, PharmD, MBA
Participating Faculty

Real-World Health Plan Claims Analysis of Differences in Healthcare Utilization and Total Cost in Patients Suffering From Cluster Headaches and Those Without Headache-Related Conditions

Michael Polson, MS, PharmD; Todd C. Lord, PharmD; Themmi M. Evangelatos, PharmD, MSBA; Maria Lopes, MD; and Briana L. Santaniello, PharmD, MBA
Patients with CH in this study were more likely to be female, which differs from most studies of CH populations, and most patients with CH had a CCI of 0. Notably, patients with CH were significantly more likely to receive a prescription across all prescription types, and the pharmacy costs for patients with CH were more than double than those for the control group. Most patients with CH can be successfully treated; however, some do not respond to therapy and may have to try alternatives until finding an effective treatment, which can lead to increased pharmacy costs and utilization.16 Earlier diagnosis and proper management of CH may help to contain pharmacy costs by streamlining the process of CH therapy.

Limitations

This analysis was based on real-world claims data. Services performed but not billed were not captured in the data. This may include physician samples for pharmaceutical products or prescriptions that are typically paid in cash, such as those on special pricing (eg, $4 generic) lists. Patients were included in the study based on an International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code for cluster headache. There may have been some misdiagnoses, including that of migraine patients, and the presence of a diagnosis code did not necessarily indicate that a headache specialist or neurologist made the diagnosis based on International Classification of Headache Disorders criteria. The specific type of cluster headache cannot always be determined with claims data.

Conclusions

These study results showed that patients identified from the data as patients with CH utilize healthcare resources at a significantly higher rate than do similar patients without a headache-related diagnosis. An unmet need exists for new treatment modalities in this patient population. More effective interventions and proper management, along with earlier diagnosis of CH, may lead to improved patient outcomes and contained CH-associated healthcare costs. 

Author affiliations: Magellan Rx Management (BLS, ML, MP, TCL, TME); Magellan Method (BLS, TCL, TME).
Funding source: This supplement was sponsored by electroCore LLC.
Author disclosures: Drs Evangelatos, Lopes, Lord, Polson, and Santaniello have disclosed that they are employees of Magellan Rx Management. Dr Evangelatos has disclosed that she also owns stock in Magellan Rx Management.
Authorship information: Acquisition of data (MP, TCL), administrative, technical, or logistic support (TCL); analysis and interpretation of data (ML, MP); concept and design (ML, MP, TCL, TME); critical revision of the manuscript for important intellectual content (BLS, TME); drafting of the manuscript (BLS, ML, TME); supervision (BLS, TCL).
Address correspondence to: bsantaniello@magellanhealth.com.
 
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