Lost earnings among triptan non-responders in the general population of Denmark: a measure of disproportionate migraine-attributed burden and of unrecognised and unmet treatment need.

Abstract

Aims: Migraine leads to substantial healthcare utilization and associated costs. However, much higher costs are attributed to lost productivity. The impact of effective migraine treatment on these costs, at the individual level, has not been well established. Even less known is the impact of treatment failure. The objective of this study was to assess lost earnings as a measure of migraine-attributed burden among triptan non-responders in Denmark.

Materials and methods: We used data from the Danish National Prescription Register and Danish Income Statistics Register over the 27-year period 1995-2021. We identified 4,979 triptan non-responders (85.9% female) and matched them for sex, age and region of residence with 14,292 continuing users of triptans (triptan responders) and 13,592 individuals from the background population (triptan never-users). We then estimated average annual individual earnings, and compared those among triptan non-responders, from 3 years prior to and 10 years after their last triptan redemption, with those among their matched triptan responders and triptan never-users over the same periods.

Results: Triptan non-responders earned significantly less than both their matched triptan responders and their matched triptan never-users. The earnings gap was evident even 3 years prior to the last triptan prescription (€4,344 and €4,356 respectively). This gap widened substantially over time, so that average cumulative earnings over the 14-year period of follow-up for each triptan non-responder were €93,684 less than those of responders and €99,485 less than those of never-users.

Limitations: There are uncertainties with regard to the reasons for triptan discontinuation (whether non-response or otherwise), and to lack of diagnostic confirmation of migraine.

Conclusions: Triptan non-response represents failure of currently available acute treatment options. It is associated with substantial and cumulative lost earnings, highlighting a disproportionate economic burden. These findings underscore the potential economic benefit of recognizing, and rectifying, unmet treatment needs in migraine management.