بار حاصل از میگرن دوره پیری در ایالات متحده:چشم انداز در حال ظهور و جاری در مدیریت بیماری و تجزیه و تحلیل اقتصادی

Objectives Migraine is often perceived as a low-impact condition that imposes a limited burden to society and the health-care system. This study reviews the current understanding of the burden of migraine in the U.S., the history of economic understanding of migraine treatment and identifies emergent trends for future studies evaluating clinical and economic outcomes of migraine treatment. Methods This study traced the history of economic articles published on migraine by performing a literature search using PubMed MEDLINE database and ancestral searches of relevant articles. The intention was not to provide an exhaustive review of every article or adjudicate between studies with different findings. Results Migraine affects millions of individuals worldwide, generally during the most productive years of a person's life. Studies show that migraineurs are underdiagnosed, undertreated, and experience substantial decreases in functioning and productivity, which in turn translates into diminished quality of life for individuals, and financial burdens to both health-care systems and employers. Economic evaluations of migraine therapies have evolved with new clinical developments beginning with cognitive-behavioral therapy, introduction of triptans, concern over medication overuse, and emergence of migraine prophylaxis. Now recent clinical studies suggest that migraine may be a progressive disease with cardiovascular, cerebrovascular, and long-term neurologic effects. Conclusions Migraine imposes a substantial burden on patients, families, employers and societies. The economic standards by which migraine and treatment are evaluated have evolved in response to clinical developments. Emerging evidence suggests that migraine is a chronic and progressive disease. If confirmed, approaches to acute and prophylactic treatments and economic evaluations of migraine treatment may require major reconsideration.

Migraine is often perceived as a low-impact condition that imposes a limited burden to society and the health-care system. This misperception persists in part because the disorder is episodic, does not shorten life expectancy, and rarely causes longterm physical disability. Because it is underdiagnosed and undercoded, analyses of claims data underestimate prevalence [1–3]. Although the percentage of adults with migraine is markedly less than that of tension-type headache (11% vs. 42%, respectively) [4], migraine nevertheless affects millions of individuals worldwide and significantly impairs sufferers’ ability to function. It is most prevalent between the ages of 25 and 55, generally the most productive years of a person’s life, generating substantial lost work time. Quantitative evidence also shows that migraineurs and other headache sufferers experience substantial decreases in functioning and productivity, which in turn translates into significant health-related quality of life (HRQoL) burdens on individuals and financial burdens to employers [5–7].rthermore, emerging evidence indicates that migraine is sometimes a progressive disease with cardiovascular, cerebrovascular, and long-term neurologic effects [8,9]. If this is the case, a rethinking of approaches to both acute and preventive therapy, as well as a reconsideration of economic evaluations of the utility of migraine treatment, is required. As with most other diseases, the understanding of and research about migraine has changed significantly, as shown in Table 1. The changes in efficacy of treatment with the introduction of triptans generated a relatively large body of literature on the economics of migraine and migraine treatments. Now, new developments in the understanding of migraine will generate new studies on the economics of migraine prevention, and our understanding of the cost-effectiveness of prophylactic treatments will continue to develop as the long-term clinical consequences of migraine are studied. In this article, we first present a review of our current understanding of the burden of migraine in the United States, and then turn to the history of our economic understanding of the treatment of migraine.

Despite its high prevalence and associated disability, migraine is not generally perceived as a serious medical condition that imposes a substantial burden upon society. Evidence suggests, however, that the burden of migraine is substantial. Those who carry that burden include patients and their families, employers, and society. Economic evaluation of migraine treatment has generally responded to clinical developments. Current studies have begun to suggest that migraine is a progressive disease that can cause vascular and long-term CNS damage. If confirmed, both the treatment and economic evaluation of migraine may require major reconsideration. This study was sponsored by the National Headache Foundation through a grant from Ortho-McNeil Neurologics, Inc.