Misdiagnosed Migraine Leads to Significant Burden on Healthcare Resource Utilization

Using Marketscan Commercial and Medicare Supplemental Databases from June 2018 to 2019, results from a recently published study showed that patients with migraine who’ve been previously misdiagnosed incur higher rates of healthcare resource utilization and costs over time vs those without such history. Overall, the data highlight the economic burden associated with the misdiagnosis of migraine.¹

The study featured 29,147 patients with a correct diagnosis of migraine and 3841 patients who were potentially misdiagnosed, then eventually received a correct diagnosis. In the analysis, patients without a history of commonly considered misdiagnoses prior to their migraine diagnosis were classified as the “correctly diagnosed cohort.” Misdiagnosis was defined as having 1 or more inpatient or 2 or more outpatient medical claims on different dates with a diagnosis of a commonly considered misdiagnosis, like headache, sinusitis, or cervical pain, in the 24 months before the index migraine diagnosis.

Led by Jae Rok Kim, PharmD, MS, a postdoctoral fellow working for AbbVie, those in the misdiagnosed cohort demonstrated statistically significantly higher rates of inpatient admissions (0.02 vs 0.01; incidence rate ratio [IRR], 1.61; 95% CI, 1.47-1.74), and emergency department visits (0.10 vs 0.05; IRR, 1.89; 95% CI, 1.79-1.99). Between the 2 cohorts, those misdiagnosed also saw higher rates of neurologist visits (0.12 vs 0.02; IRR, 5.95; 95% CI, 5.40-6.57), non-neurologist outpatient visits (2.64 vs 1.58; IRR, 1.67; 95% CI, 1.62-1.72), and prescription fills (2.82 vs 1.84; IRR, 1.53; 95% CI, 1.48-1.58).

Coming into the study, patients from both cohorts were primarily female (77-81%), with commercial insurance (97-99%), and subscribed to an exclusive provider organization/preferred provider organization plan or consumer-driven health plan/high-deductible health plan. In addition to increased healthcare resource utilization, those in the misdiagnosed cohort demonstrated statistically significantly higher rates of cost accrual across all care settings compared with those in the correct diagnosis group.

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In the data, those with a misdiagnosis of migraine had statistically significantly higher rates of cost accrual for inpatient admissions (IRR, 2.62; 95% CI, 2.50-2.75), emergency department visits (IRR, 2.27; 95% CI, 2.18-2.36), and neurologist visits (IRR, 4.39; 95% CI, 4.00-4.79). In addition, this group also had higher accrued costs for non-neurologist outpatient visits (IRR, 2.07; 95% CI, 1.91-2.24) and higher prescription fills (IRR, 1.41; 95% CI, 1.18-1.70) relative to the correct diagnosis patients.

"The next step would be to analyze the implications after the diagnosis has occurred," study authors concluded. "The long-term implication of misdiagnosis is another question that remains unanswered. It is important to consider that this study only focused on the direct costs associated with a misdiagnosis of migraine. Characterization of the indirect costs, such as productivity loss or workday loss associated with a misdiagnosis, would fully capture the personal loss to the patient due to a misdiagnosis."

A misdiagnosis was linked to an increase in costs per patient per month (PPPM), including $844 (95% CI: $587–$1100) higher inpatient costs, $124 (95% CI: $97–$151) higher emergency department costs, $33 (95% CI: $10–$56) higher neurologist costs, $686 (95% CI: $531–$841) higher non-neurologist costs, and $90 (95% CI: $2–$178) higher prescription costs compared to the CD cohort.

Patients with multiple misdiagnoses had significantly higher healthcare resource utilization and cost accrual rates across all care settings compared to the correctly diagnosed cohort. This included increased rates of inpatient admissions (HCRU: IRR, 1.69 [95% CI 1.49–1.90] cost: IRR, 2.73 [95% CI 2.52–2.94]), ED visits (HCRU: IRR, 2.13 [95% CI 1.96–2.31] cost: IRR, 2.77 [95% CI 2.64–2.90]), neurologist visits (HCRU: IRR, 7.76 [95% CI 6.72–9.00] cost: IRR, 5.86 [95% CI 5.31–6.40]), non-neurologist outpatient visits (HCRU: IRR, 1.86 [95% CI 1.78–1.93] cost: IRR, 2.10 [95% CI 1.88–2.35]), and prescription fills (HCRU: IRR, 1.60 [95% CI 1.52–1.69] cost: IRR, 1.55 [95% CI 1.18–2.10]).

REFERENCE
1. PharmD JRK, Park TJ, Agapova M, et al. Healthcare resource use and costs associated with the misdiagnosis of migraine. Headache. 2025;65(1):35-44. doi:10.1111/head.14822