Study Highlights Rapid Increase of Inpatient Migraine Cost Burden

Between 1997 and 2012, the inpatient burden of migraine cost rapidly increased in the United States, according to a study published in Plastic and Reconstructive Surgery-Global Open.

Migraine affects nearly 1 in 7 Americans every year and tends to affect women more than men. Most patients develop migraine between ages 25 and 55, so that the condition can become most burdensome to women during childbearing years.

In addition to high direct medical costs suffered by individuals and hospitals, indirect costs from occupational disability and loss of productivity are also incurred, the authors note. Current estimates value migraine’s total economic impact on the United States between $13 billion and $17 billion annually.

To determine the longitudinal trends of inpatient migraine burden, the researchers collected data from the Nationwide Inpatient Sample of the Hospitalization Cost and Utilization project databases over a 15-year time period.

“Inpatient costs were reported in dollars for the cost to the institution, whereas charges reflect the amount billed,” according to the researchers. To illustrate year-to-year changes, the parameters were trended and the average annual percent change (AAPC) was calculated.

Data revealed discharges for migraine headaches reached a low of 30,761 in 1999 before increasing to 54,510 in 2012, while total inpatient charges increased from $176 million in 1999 to $1.2 billion in 2012.

Between 1997 and 2012:

• Annual charges for migraine headache increased 484%, from $201 million to $1.18 billion per year, with an AAPC of 12.5%
• Annual charges for all diagnoses increased 257%, from $375 billion to $1.34 trillion per year, with an AAPC of 9.0%
• Average length of stay for migraine headaches decreased from 3.5 to 2.8 days.
• Charges per day for migraine headache increased from $1701 in 1997 to $4566 in 2006 and $7706 in 2012, marking an increase of 353% from 1997 to 2012 and 69% from 2006 to 2012, with an AAPC of 9.1%

The researchers also found hospital charges increased “from $5939 per admission and $176 million nationwide in 1997 to $21,576 per admission and $1.2 billion nationwide in 2012.” Costs per day also increased 31% from $1612 to $2111 from 2006 to 2012, with an AAPC of 4.6%

Prevalence of migraine among Americans remained stable throughout the study period, affecting roughly 1 in 7 individuals in both 1997 and 2012. However, the increase in charges outpaced the collective rate for all diagnoses and inflation, the authors note. They hypothesize the cause of the increases is multifactorial, with the largest contributing factor being inpatient charges per day. Changing daily charges could be a result of possible changes in cost of medications or pressures imposed on health care institutions to increase revenue. More costly inpatient treatment programs for migraines may also contribute to the increased charges.

One limitation to the study is the lack of itemized breakdowns of the components of charge and cost information.

In future studies, “causes of the rise in charges and costs, as well as the discrepancy between hospital charges and cost, should be evaluated alongside actual reimbursement,” the authors said. “Better prevention and improved outpatient treatment may help alleviate the inpatient burden of migraine,” they conclude.

Reference

Law H-Z, Chung MH, Nissan G, Janis JE, Amirlak B. Hospital burden of migraine in United States adults: a 15-year national inpatient sample analysis. Plast Reconstr Surg Glob Open. Published online April 23, 2020. doi:10.1097/GOX.0000000000002790