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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.