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. 2020 May 4;21(1):44.
doi: 10.1186/s10194-020-01115-4.

Direct and indirect costs of cluster headache: a prospective analysis in a tertiary level headache centre

Andrea Negro  1   2 , Paolo Sciattella  3   4 , Valerio Spuntarelli  5 , Paolo Martelletti  5   6 , Francesco Saverio Mennini  3   7
Affiliations

Direct and indirect costs of cluster headache: a prospective analysis in a tertiary level headache centre

Andrea Negro et al. J Headache Pain. .

Abstract

Background: Cluster headache (CH) is the most frequent trigemino-autonomic cephalgia. CH can manifest as episodic (ECH) or chronic cluster headache (CCH) causing significant burden of disease and requiring attack therapy and prophylactic treatment. The few data available on the economic burden of CH come from retrospective studies based on questionnaires, population surveys and medical insurance claims database. Although all these studies showed an important economic burden, they provided different estimates depending on variability of CH awareness and management, healthcare systems, available therapies and use of treatments according to different guidelines.

Methods: This prospective study aimed to quantify the total direct and indirect cost of ECH and CCH over a cluster period, both for the patient and for the National Health System (NHS), using data from subjects who consecutively attended an Italian tertiary headache centre between January 1, 2018 and December 31, 2018.

Results: A total 108 patients (89 ECH, 19 CCH) were included. Mean attack frequency was 2.3 ± 1.4 per day. Mean total cost of a CH bout was €4398 per patient and total cost of CCH was 5.4 times higher than ECH (€13,350 vs. €2487, p < 0.001). Direct costs represented the 72.1% of total cost and were covered for the 94.8% by the NHS. The costs for any item of expense were higher for CCH than for ECH (p < 0.001). Mean indirect costs for a CH bout were €1226 per patient and were higher for CCH compared to ECH (€3.538 vs. €732), but the difference was not significant. Days with reduced productive capacity impacted for the 64.6% of the total indirect costs. The analysis of the impact CH on work showed that 27%% of patients felt that CH had limited their career, 40% had changed their work pattern, 20% had changed their place of employment and 10% had lost a job due to the disease.

Conclusion: Our results provide a valuable estimate of the direct and indirect costs of ECH and CCH in the specific setting of a tertiary headache centre and confirm the high economic impact of CH on both the NHS and patients.

Keywords: Burden of disease; Chronic cluster headache; Cluster headache; Cost of illness; Episodic cluster headache; Resource utilization.

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Conflict of interest statement

A. Negro received travel grants, consulting fees and speaking fees from Allergan, Eli Lilly, Novartis, and TEVA.

P. Martelletti received travel grants, consulting fees and speaking fees from Allergan, Amgen, Eli Lilly, Novartis, and TEVA.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Figures

Fig. 1
Fig. 1
Reported work efficiency during a cluster period
Fig. 2
Fig. 2
Reports of work changes due to cluster headache. Legend: * p < 0.0001; #p = 0.022
Fig. 3
Fig. 3
Direct costs per cluster headache patient
Fig. 4
Fig. 4
Total costs per cluster headache patient
See this image and copyright information in PMC

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