The cost of migraine to the NHS in England: a retrospective cohort study using electronic health record data from Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)

To quantify the healthcare resource utilization (HCRU) and associated direct medical costs of migraine among adults in England and compare with general population controls. This retrospective cohort study used linked primary and secondary healthcare data (Clinical Practice Research Datalink Aurum [CPRD] and Hospital Episode Statistics [HES]) in England. Migraine cases (adults newly diagnosed with migraine between 1-Jan-2017 and 31-Mar-2019) and general population controls were matched on age, sex, ethnicity, practice region, Index of Multiple Deprivation 2019, and baseline depression and cardiovascular disease. All-cause HCRU and costs were estimated for cases and compared with controls using Fisher's Exact and Mann-Whitney U tests. Subgroup analyses were conducted by migraine treatment group (acute only, preventative only, acute and preventative, no treatment). A total of 62,143 migraine cases and matched controls were identified, of which 76.2% (n = 47,376) were female and the mean [SD] age at index was 39.8 [15.5] years. All-cause direct medical costs per-person per-year (pppy) were approximately 81% greater (p < 0.0001) in those with migraine (median [Q1, Q3]: £492 [£205, £1,149]) than controls (£272 [£101, £716]). The acute and preventative treatment subgroup had the highest all-cause direct costs pppy (£925 [£430, £2,046]). Overall, patients diagnosed with migraine contribute a substantially larger cost burden on the healthcare system than their matched controls, with costs largely driven by interactions in secondary care. Costs also varied depending on types of migraine treatment received and may reflect differences in migraine presentation, such as chronicity and patient needs, as well as suboptimal management of migraine in primary care.