Real-World Healthcare Utilization and Costs in Migraine Patients in Ontario, Canada

A comprehensive understanding of the burden of migraine in Canada is needed to inform clinicians, clinical care and policymakers. This study assessed real-world healthcare resource utilization (HCRU) and costs of patients with episodic migraine (EM) and chronic migraine (CM) in Ontario, Canada.

This study utilized administrative databases from the Institute for Clinical Evaluative Sciences (ICES) containing publicly funded health services records for the covered population of Ontario. Patients ≥26 years old with a migraine diagnosis between January 2013 and December 2017 were selected. EM and CM were inferred in eligible patients based on previously studied predictors. Cases were matched with non-migraine controls and followed for two years.

452,431 patients with migraine, 117,655 patients inferred with EM and 24,763 patients inferred with CM were selected and matched to controls. 39.4% of the inferred EM and 69.3% of the inferred CM subpopulations had ≥1 claims of preventive medications. Migraine-specific acute medications were underutilized (EM: 1.0%, CM: 3.3%), and high proportions of patients utilized opioids (EM: 38.8%, CM: 64.9%). Mean all-cause two-year costs per patient for the overall migraine population and inferred EM and CM subpopulations were $7,486 (CAD), $11,908 (CAD) and $24,716 (CAD), respectively. The two-year incremental all-cause cost of migraine to the Ontario public payer was $1.1 billion (CAD).

Migraine poses a significant unmet need and burden on the Canadian healthcare system. These results demonstrate a gap between real-world care and recommendations from treatment guidelines, emphasizing the need for improved awareness and expanded access to more effective treatment options.