Understanding the Opportunities in Dual Therapy and Emergency Department Utilization in Migraine Care.

Document Type

Article

Publication Date

2025

Publication Title

Neurology. Clinical Practice

Abstract

BACKGROUND AND OBJECTIVES: Value-based payment (VBP) models require organizations to understand conditions that are contributing to spending and utilization above negotiated targets. Headache was a top 10 reason for an emergency department (ED) visit in 2022. The high utilization continued with more than 2,000 ED visits for migraine in 2023. Nearly all these visits resulted in same-day discharge home, suggesting these may be avoidable. A Payvider council was used to affect medical policy change, and dual therapy for migraine treatment (concurrent use of anti-calcitonin gene-related peptide medications and onabotulinumtoxinA) was approved for coverage in May 2023. This study provides insight into the effect on cost and ED utilization of the medical policy change enabling dual therapy treatment of migraine by comparing cost for pharmacy and ED utilization across monotherapy or dual therapy patient groups.

METHODS: Patients with a prescription for 1 (monotherapy) or both (dual therapy) medications of interest with an ED encounter for migraine were reviewed. Based on the medications prescribed, patients were classified as receiving monotherapy or dual therapy for the treatment of migraine. The rates of emergency department utilization, ED utilization costs, and pharmacy costs were compared between the groups. This analysis was extrapolated to the larger migraine population within the organization to understand the cost effect of changing migraine management to the organization.

RESULTS: Three hundred fifty-seven health plan members used the ED posttreatment between January 1, 2023, and December 31, 2023. A significant difference (

DISCUSSION: Dual therapy for migraine had a positive effect on ED visit utilization in our sample while also having cost implications. Health care systems and neurology providers may benefit from this assessment when establishing migraine care, developing data structures, and planning for VBP models.

Volume

15

Issue

5

First Page

e200519

Last Page

e200519

DOI

2025;15(5):e200519

ISSN

2163-0402

PubMed ID

40852534

Link to Full Text

Share

COinS