A new study finds that behavioral interventions are a cost-effective method to care for migraines.
Researchers discovered clinical strategies including relaxation training, hypnosis, and biofeedback were financially viable options as compared to prescription-drug treatment — especially if the condition continued for a year or more.
Dr. Donald Penzien, coauthor of the study, comments that the costs of prescription prophylactic drugs — the kind chronic migraine sufferers take every day to prevent onset — may not seem much even at several dollars a day. “But those costs keep adding up with additional doctor visits and more prescriptions.”
“The cost of behavioral treatment is front-loaded. You go to a number of treatment sessions but then that’s it. And the benefits last for years.”
The study compared the costs over time of several types of behavioral treatments with prescription-drug treatments with the findings discussed in the journal Headache.
The investigators found that after six months, the cost of minimal-contact behavioral treatment was competitive with pharmacologic treatments using drugs costing 50 cents or less a day. Minimal-contact treatment is when a patient sees a therapist a few times but largely practices the behavioral techniques at home, aided by literature or audio recordings.
After one year, the minimal-contact method was nearly $500 cheaper than pharmacologic treatment.
“We have a whole armamentarium of behavioral treatments and their efficacy has been proven. But headache sufferers are only getting a tip of these options,” said Dr. Timothy Houle, associate professor of anesthesiology and neurology at Wake Forest University, and the study’s principal investigator.
“One reason is people think behavioral treatment costs a lot. Now with this study, we know that the costs are actually comparable, if not cheaper, in the long run.”
At a time when health-care costs are under national scrutiny, the study offers a framework for comparing costs that researchers can update and use for years to come.
“We thought, ‘Wouldn’t it be fun to model this and see how it comes out over time?’” Penzien said. “All the figures are there so if someone disagrees with it, they can plug in their own numbers.”
The researchers didn’t compare the effectiveness of methods, nor did they calculate the costs over time of individual drugs, since dosages and prices vary widely. Rather, they figured the per-day costs of each method based on fees of physicians and psychologists. For the physician group, they added in the cost of prescription beta-blocker drugs at various prices.
For instance, among the psychologists surveyed, one-on-one behavioral sessions cost between $70 and $250 for the intake visit and $65 and $200 for follow-up visits. That put the median intake cost at $175 and median follow-up cost at $125 for a median 10 visits.
The researchers calculated the median cost of pharmacologic approaches at $250 for the intake session and a professional fee of $140 per session. Median time to the first follow-up was 52.2 days, rising to 60 for the second with a median five visits per year.
Even the most expensive behavioral treatment method becomes competitive with a pharmacological approach if compared over a modest period.
For example, individual sessions with a psychologist in clinic cost more than pharmacologic treatment with $6-a-day drugs in the first months. But at about five months, individual sessions become competitive. After a year, they are cheaper than all methods except treatment with drugs costing 50 cents or less a day.
Overall, group therapy and minimal-contact behavioral treatment were cost-competitive with even the cheapest medication treatment in the initial months. At one year, they become the least-expensive headache treatment choice.
Source: University of Mississippi