High Cost of Cluster Headache in the US

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Among individuals who suffer from cluster headache, almost 18% of total healthcare costs are related to the condition, and over $3000 is lost per person per year due to missed work days and short-term disability, according to a study published online on November 10, 2017 in the Journal of Medical Economics.¹

“In this real-world analysis, patients with cluster headache have high healthcare costs that are associated with inpatient admissions and pharmacy fulfillments, and high indirect costs associated with absenteeism and short-term disability,” wrote first author Janet Ford, PhD, MPH, of Eli Lilly and Company and her colleagues.

The study is the first to describe the direct costs and indirect costs of cluster headache in the US.

Cluster headache, though relatively rare. . . about 1 in 1000 Americans is affected . .  can be debilitating. Symptoms include short attacks that last 15-180 minutes, along with severe one-sided pain, usually around or above the eye or affecting the temporal area. Because the cranial autonomic nerves can be affected, patients may also have tearing, red eyes, runny nose, nasal congestion, and restlessness.  Several cluster headaches can occur on the same day, though attacks are also periodic.  

People who suffer from cluster headaches often have increased healthcare utilization and decreased productivity. One study estimated that 20% of those with cluster headache have lost their job due to their condition, and 8% are unemployed or on disability.  However, that study could not put a number on the costs of cluster headache.²

To estimate these costs, researchers analyzed data in Marketscan databases, which have information on commercial Medicare claims as well as work absence, short term disability, and workers comp. The study included claims from 9328 adults (mean age 44.6 years, 61.4% male) with cluster headache between January 2009 and June 2014. Direct healthcare costs included outpatient visits, inpatient, hospitalization, surgery, and pharmacy claims. Indirect costs included work absenteeism and short-term disability. Costs were adjusted for inflation.

Key results
• All-cause direct costs: $17,574 per person per year (PPPY)
o 17.8% of all-cause direct costs were related to cluster headache ($3,132 PPPY)
o >75% of cluster headache-related direct costs were due to hospitalizations ($1,604 PPPY) and pharmacy ($809 PPPY)
• Indirect costs:
o Works hours lost: 78% for absenteeism, 23% for short-term disability
o Absenteeism: 224 hours lost PPPY, at a cost of $4,928 PPPY
o Short-term disability: 61 hours lost PPPY, at a cost of $803 PPPY
o Absenteesim + disability: 256 PPPY, at a cost of $3,374 PPPY

The authors noted that because the study used claims data, the results may not generalize to people without employer-sponsored health insurance or those who are uninsured. Also, migraine could have been misclassified as cluster headache and vice versa, because about one-third of patients in this study were considered to have comorbid chronic migraine. Finally, indirect cost calculations were limited by the wide range of occupations and salaries, ranging from entry level to upper management. 

Take Home Points
• The first study to evaluate the direct and indirect costs of cluster headache in the US found that it contributes to almost 18% ($3132 PPPY) of total healthcare costs among people who suffer from the condition
• 78% of work hours lost related to cluster headache are due to absenteeism, at a cost of $4928
• Cluster headache, though relatively rare, carries a high burden related to increased direct healthcare costs for hospitalizations and medication, and increased indirect costs related to work absenteeism, and short-term disability

References:

1. Ford JH, Nero D, Kim G, et al. Societal burden of cluster headache in the United States: a descriptive economic analysis. J Med Econ.2017 Nov 10:1-11.
2. Rozen TD, Fishman RS. Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache. 2012 Jan;52(1):99-113. Epub 2011 Nov 11.