Migraine Prevalence and QALY Loss in Serbia: A Population-Level Stratified Modeling Study

To estimate age- and sex-specific migraine prevalence in Serbia and annual quality-adjusted life-year (QALY) loss among adults with definite or probable migraine using a population-level stratified model.

Global Burden of Disease (GBD) 2023 prevalence estimates for definite migraine, probable migraine, and total medication-overuse headache (MOH) in Serbia were applied to final 2022 Serbian Census counts by single year of age and sex; 73.2% of total MOH was attributed to migraine. Epidemiological estimates included residents aged 5 years or older, whereas the primary one-year QALY analysis included adults aged 18 years or older with definite or probable migraine. Annual QALY loss equaled modeled case counts multiplied by the GBD 2023 proportion of time symptomatic and the paired EQ-5D-5L migraine-day utility decrement of 0.364. A 100,000-iteration probabilistic sensitivity analysis sampled 12 symptom-time parameters and one shared utility-decrement parameter from normal distributions truncated to [0,1], with prevalence fixed. No episodic/chronic split or attack-frequency assumptions were imposed.

The model estimated 952,369 residents aged 5 years or older with migraine (crude modeled prevalence, 15.0%). Among adults, 794,380 with definite or probable migraine were included in the primary QALY analysis, whereas 85,364 with MOH attributable to migraine were reported epidemiologically only. Deterministic annual QALY loss was 21,951, or 0.0276 QALY (10.1 full-health-equivalent days) per included adult. Across 100,000 probabilistic iterations, mean annual loss was 21,949 QALYs (95% uncertainty interval, 20,203-23,736).

Migraine represents a substantial modeled population-health burden in Serbia. The primary estimate excluded pediatric, MOH-related, and additional interictal QALY loss. It provides a transparent national benchmark for migraine recognition, referral, health-related quality-of-life measurement, and evaluation of preventive-care access, but does not establish intervention effectiveness or cost-effectiveness.