Societal burden of cluster headache in the United States: a descriptive economic analysis

Abstract

Aim: To estimate direct and indirect costs in patients with a diagnosis of cluster headache in the US.

Methods: Adult patients (18–64 years of age) enrolled in the Marketscan Commercial and Medicare Databases with ≥2 non-diagnostic outpatient (≥30 days apart between the two outpatient claims) or ≥1 inpatient diagnoses of cluster headache (ICD-9-CM code 339.00, 339.01, or 339.02) between January 1, 2009 and June 30, 2014, were included in the analyses. Patients had ≥6 months of continuous enrollment with medical and pharmacy coverage before and after the index date (first cluster headache diagnosis). Three outcomes were evaluated: (1) healthcare resource utilization, (2) direct healthcare costs, and (3) indirect costs associated with work days lost due to absenteeism and short-term disability. Direct costs included costs of all-cause and cluster headache-related outpatient, inpatient hospitalization, surgery, and pharmacy claims. Indirect costs were based on an average daily wage, which was estimated from the 2014 US Bureau of Labor Statistics and inflated to 2015 dollars.

Results: There were 9,328 patients with cluster headache claims included in the analysis. Cluster headache-related total direct costs (mean [standard deviation]) were $3,132 [$13,396] per patient per year (PPPY), accounting for 17.8% of the all-cause total direct cost. Cluster headache-related inpatient hospitalizations ($1,604) and pharmacy ($809) together ($2,413) contributed over 75% of the cluster headache-related direct healthcare cost. There were three sub-groups of patients with claims associated with indirect costs that included absenteeism, short-term disability, and absenteeism + short-term disability. Indirect costs PPPY were $4,928 [$4,860] for absenteeism, $803 [$2,621] for short-term disability, and $3,374 [$3,198] for absenteeism + disability.

Conclusion: Patients with cluster headache have high healthcare costs that are associated with inpatient admissions and pharmacy fulfillments, and high indirect costs associated with absenteeism and short-term disability.

Keywords:

• Direct and indirect cost analysis
• cluster headache
• claims
• absenteeism
• short-term disability
• healthcare resource utilization

Transparency

Declaration of funding

The study sponsor (Eli Lilly and Company, Indianapolis, IN) funded the study and was involved in the study design, data interpretation, and writing of the article. Truven Health Analytics, an IBM Company, was involved in the study design, data collection, data analysis, data interpretation, and writing of the article. All authors had full access to all data and had final responsibility for the decision to submit for publication. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship.

Declaration of other/financial relationships

JHF, JA, and JMM are employees of Eli Lilly and Company, Indianapolis, IN. GK and RF are employees of Truven Health Analytics, an IBM Company, Ann Arbor, MI. DN and BCC were employed at Truven Health Analytics at the time that the study was conducted. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.