Real-world health plan claims analysis of differences in healthcare utilization and total cost in patients suffering from cluster headaches and those without headache-related conditions

Am J Manag Care. 2017 Nov;23(16 Suppl):S295-S299.


Background: According to the World Health Organization, headache disorders are underappreciated by many health systems. These disorders have a substantial impact on quality of life, yet the true correlation between headache conditions and increased total healthcare utilization is not well understood. This study further explores the impact of headache conditions on healthcare utilization.

Objectives: To assess differences in healthcare utilization and total cost in patients suffering from cluster headaches (CH) compared with patients without headache-related conditions.

Methods: Medical and pharmacy claims data from 4 regional health plans were used to evaluate differences in healthcare utilization and cost in patients with a diagnosis code for CH (chronic, episodic, or unspecified) from International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification compared with a control group of patients without headache-related conditions. Qualifying patients were aged at least 18 years and continuously eligible for their health plan for 3 consecutive years during the study period (January 1, 2009-December 31, 2015). The first date with a diagnosis of CH was considered the index date and the subsequent 3 years of claims data were used for this retrospective analysis. The CH cohort was matched with controls using propensity score matching. Differences between cohorts (CH vs control) were assessed with t test or Fisher's exact test as appropriate.

Results: A total of 4174 patients with diagnosis codes for CH met the study criteria and were matched 1:1 with controls (gender: 48% male; mean age: 47 years; mean Charlson Comorbidity Index score: 0.30). Mean medical costs per patient in the CH cohort during the 3-year measurement period were 155% higher than those of the control group ($25,805 vs $10,140, respectively). Unique encounters and cost per patient by medical services type for the CH cohort compared with the control group were as follows (encounters [costs]): emergency department: 2151 ($1986) versus 962 ($1268); hospital inpatient: 900 ($7312) versus 253 ($8528); hospital outpatient: 3422 ($12,459) versus 2141 ($7644); physician office: 4113 ($7379) versus 4089 ($3672); home infusion/specialty medications: 817 ($4977) versus 427 ($1720). Visit counts per patient were significantly higher for CH patients in all categories. Mean pharmacy costs per patient for the CH cohort were more than double that of the control group ($9197 vs $4368), with these patients 2.3 times as likely to fill a prescription for an opioid.

Conclusions: The results of this analysis show that CH patients utilize healthcare resources at a significantly higher rate and cost the healthcare system significantly more than similar patients without headache-related conditions. There is an unmet need for new treatment modalities in this patient population to improve outcomes and contain cost.

MeSH terms

  • Adult
  • Cluster Headache / economics*
  • Comorbidity
  • Female
  • Health Resources / economics*
  • Health Resources / statistics & numerical data*
  • Humans
  • Insurance Claim Review / statistics & numerical data*
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Retrospective Studies