Table 1 Treatment uptake, use of resources and lost productivity according to treatment management plan (Luxembourg)
Headache type | Current care (%) | Target care (%) | Notes | ||
|---|---|---|---|---|---|
Uptake (including coverage and adherence) | Migraine | 83.8 | 91.9 | Current care: 72.1% migraine non-specific; 7.1% migraine specific; 4.6% migraine prophylaxis (see treatment plan below) Target care: We assumed that structured services with consumer education and provider training enhances coverage and adherence so that uptake is increased by 50% of current deficit: medicines uptake = [{100% - 83.8%}/2] + 83.8%) = 91.9% | |
TTH | 58.2 | 79.1 | Current care: 58.2% acute medications; 0% TTH prophylaxis (see treatment plan below) Target care: We assumed as above: medicines uptake = [{100% - 58.2%}/2] + 58.2%) = 79.1% | ||
MOH | 0 | 50.0 | Current care: 0% treated Target care: We assumed that structured services with consumer education and provider training enhances treatment coverage and adherence so that proportion withdrawn from medicines overuse is increased by 50% of current deficit: withdrawal = [{100–0%}/2] + 0%) = 50.0% | ||
TREATMENT PLAN | |||||
A. Acute management (non-specific drugs) | |||||
Simple analgesics (eg, ASA 1 g) | Migraine | 72.1 | 46.0 | Current care: from Eurolight data [20] Target care: With consumer education and provider training, treatment with simple analgesics alone is used by or offered to 50% (expert assumption), with uptake = 46.0% (50% of 91.9%) | |
TTH | 55.6 | 76.7 | Current care: from Eurolight data [20] Target care: With consumer education and provider training, treatment with simple analgesics alone is used by or offered to 97% (expert assumption), with uptake 76.7% (97% of 79.1%) | ||
MOH | 0 | 0 | Not applicable to MOH care | ||
B. Acute management (specific drugs) | |||||
Sumatriptan 50 mg | Migraine | 7.1 | 0 | Current care: from Eurolight data [20] Target care: With provider training, treatment with specific drugs alone is offered to 0% (expert assumption) | |
TTH | 0 | 0 | Not applicable to TTH care | ||
MOH | 0 | 0 | Not applicable to MOH care | ||
C. Acute stepped-care management | |||||
ASA 1 g + sumatriptan 50 mg | Migraine | 0 | 18.4 | Current care: not included in current care Target care: With provider training, acute stepped-care management is offered to 20% (expert assumption), with uptake = 18.4% (20% of 91.9%) | |
TTH | 0 | 0 | Not applicable to TTH care | ||
MOH | 0 | 0 | Not applicable to MOH care | ||
D. Prophylaxis + acute management | |||||
Amitriptyline 100 mg/day + ASA 1 g + sumatriptan 50 mg | Migraine | 4.6 | 27.6 | Current care: from Eurolight data [20] Target care: With provider training, prophylaxis + acute stepped-care management is offered to 30% (expert assumption), with uptake = 27.6% (30% of 91.9%) | |
TTH | 0 | 2.4 | Current care: not included in current care Target care: With provider training, prophylaxis + acute care management is offered to 3% (expert assumption), with uptake = 2.4% (3% of 79.1%) | ||
MOH | 0 | 0 | Not applicable to MOH care | ||
Consultations and investigations | |||||
Doctor visits (year 1) | Migraine | 25.1 | 50.0 | Current care: 25.1% with migraine had seen a doctor (Eurolight data [20]), of whom 19.3% had seen a GP and 5.8% a specialist. We assumed 2 visits in either case. Target care: With consumer education, 50% see a doctor (expert assumption based on estimated need for professional care). Note that in the model those who see a specialist would see a GP first. | |
TTH | 9.4 | 2.25 | Current care: 9.4% with TTH had seen a doctor (Eurolight data [20]), of whom 6.9% had seen a GP and 2.5% a specialist. We assumed 2 visits in either case. Target care: With consumer education, 3% (Stovner 2007 [21]) × 75% = 2.25% see a specialist and none see a GP (expert assumption based on estimated need for professional care). Note that those who see a specialist would see a GP first. | ||
MOH | 51.2 | 100 | Current care: 51.2% with MOH had seen a doctor (Eurolight data [20]), of whom 21.6% had seen a GP and 29.6% a specialist. We assumed 2 visits in either case. Target care: With consumer education, 100% see a doctor (expert assumption based on estimated need for professional care). Note that those who see a specialist would see a GP first. | ||
GP visits | Migraine | 19.3 | 45.0 | Current care: 19.3% had seen a GP (Eurolight data [20]) Target care: With consumer education, 45.0% (90% of 50%) see a GP (we assumed 2 visits in a year) | |
TTH | 6.9 | 0 | Current care: 6.9% had seen a GP (2 times in a year) (Eurolight data [20]) Target care: Chronic TTH is difficult to treat, so we assumed that all should go to levels 2 or 3 (ie, “specialists”). Note that those who see a specialist would see a GP first. | ||
MOH | 21.6 | 100 | Current care: 21.6% had seen a GP (2 times in a year) (Eurolight data [20]) Target care: With consumer education, 100% see a GP (we assumed 2 visits in a year) | ||
Specialist visits | Migraine | 5.8 | 5.0 | Current care: 5.8% had seen a specialist (2 times in a year) Target care: With consumer education and provider training, 5.0% (10% of 50%) see a specialist (we assumed 2 visits in a year) | |
TTH | 2.5 | 2.25 | Current care: 2.5% had seen a specialist (2 times in a year) Target care: With consumer education and provider training, 2.25% see a specialist (we assumed 2 visits in a year) | ||
MOH | 29.6 | 100 | Current care: 29.6% saw a GP (2 times in a year) Target care: With consumer education and provider training, 100% see a specialist (we assumed 2 visits in a year) | ||
Investigations (MRI) (year 1) | Migraine | 8.5 | 1.0 | Current care: All those seeing a specialist had MRI (one in a year) Target care: With provider training, we assumed 1% have MRI (one in a year) | |
TTH | 1.0 | 0.5 | Current care: 1% had an MRI Target care: We assumed 0.5% have MRI examination (one in a year) – half the current estimate | ||
MOH | 0 | 0 | Current care: Nobody had an MRI Target care: Nobody has an MRI | ||
Doctor visits (years 2–5) | Migraine | 24.6 | 50.0 | Current care: 24.6% with migraine had seen a doctor (Eurolight data [20]), of whom all saw a GP only after year 1. We assumed 2 visits per year. Target care: With consumer education, 50% see a doctor (expert assumption based on estimated need for professional care) | |
TTH | 9.4 | 2.25 | Current care: 9.4% with TTH had seen a doctor (Eurolight data [20]), of whom all saw a GP only after year 1. We assumed 2 visits per year. Target care: With consumer education, 3% (Stovner 2007 [21]) × 75% = 2.25% see a doctor (expert assumption based on estimated need for professional care). Note that those who see a specialist would see a GP first. | ||
MOH | 51.2 | 100 | Current care: 51.2% with MOH had seen a doctor (Eurolight data [20]), of whom all saw a GP only after year 1. We assumed 2 visits per year. Target care: With consumer education, 100% see a doctor | ||
GP visits | Migraine | 24.6 | 50.0 | Current care: 24.6% saw a GP. We assumed 2 visits each year. Target care: With consumer education, 50% see a GP. We assumed 2 visits each year. | |
TTH | 9.4 | 0 | Current care: 9.4% saw a GP. We assumed 2 visits each year. Target care: Chronic TTH is difficult to treat, so we assumed that all should go to levels 2 or 3 (ie, “specialists”). Note that those who see a specialist would see a GP first. | ||
MOH | 51.2 | 100 | Current care: 51.2% saw a GP. We assumed 2 visits each year. Target care: With consumer education, 100% see a GP. We assumed 2 visits each year. | ||
Specialist visits | Migraine | 0 | 0 | Current care: No visits after year 1 Target care: No visits after year 1 | |
TTH | 0 | 2.25 | Current care: No visits after year 1 Target care: With consumer education and provider training, 2.25% see a specialist (we assumed 2 visits in a year). | ||
MOH | 0 | 0 | Current care: No visits after year 1 Target care: No visits after year 1 | ||
Investigation (MRI) (years 2–5) | Migraine | 0 | 0 | Current care: nobody had an MRI after year 1 Target care: nobody had an MRI after year 1 | |
TTH | 0 | 0 | Current care: nobody had an MRI after year 1 Target care: nobody had an MRI after year 1 | ||
MOH | 0 | 0 | Current care: nobody had an MRI after year 1 Target care: nobody had an MRI after year 1 | ||
Lost productivity | We assumed that lost work productivity was correlated with disease-attributed disability, and reduced disability would bring reduced lost productivity. In our baseline scenario, all lost productivity was explained by disease-attributed disability. | ||||
Days lost from work in 12 months | Migraine | 7.6 | 2.4 | Current care: Based on Eurolight data [16] Target care: We assumed 69% decrease in lost productivity (equal to the gain in HLYs reported for migraine (see Table 4)): 7.6-(7.6*0.69) = 2.4 days. | |
TTH | 3.2 | 1.0 | Current care: Based on Eurolight data [16] Target care: We assumed 76% decrease in lost productivity (equal to the gain in HLYs reported for TTH (see Table 4)): 3.2-(3.2*0.76) = 1.0 days. | ||
MOH | 22.8 | 7.1 (if revert to migraine); 5.5 (if revert to TTH) | Current care: Based on Eurolight data [16] Target care: For individuals reverting to migraine, we assumed 69% decrease in lost productivity (equal to the gain in HLYs reported for migraine (see Table 4)): 22.8-(22.8*0.69) = 7.1 days For individuals reverting to TTH, we assumed 76% decrease in lost productivity (equal to the gain in HLYs reported for TTH (see Table 4)): 22.8-(22.8*0.76) = 5.5 days. | ||