Patients with migraine prefer preventive migraine treatments that have improved efficacy, greater tolerability, and lower risk for adverse events (AE), according to a study published in Headache.
Investigators analyzed a web-based discrete-choice experiment survey to find patients’ preferences for preventive migraine treatment. Patients with migraine (N=300) were asked to choose between pairs of hypothetical preventive migraine medication profiles, which were defined by a set of 6 medicine attributes that had 3 varying levels. Efficacy was defined as a reduction in headache days per month (10%, 25%, or 50%) and frequency of limitations with physical activities (none, 1-category improvement, or 2-category improvement). Attributes related to AE were problems with cognition (no problems, thinking problems, or memory problems), and weight gain (none, 5% body weight gain, or 10% body weight gain). Respondents also answered questions on frequency and mode of administration (daily oral pill, once-monthly injection, or twice-monthly injection), and monthly out-of-pocket cost ($5, $60, or $175).
Respondents reported having a mean of approximately 16 headache days per month, with 72% reporting that migraine hindered physical activities all or most of the time. In the previous 6 months, 81% of respondents had taken preventive medicine for migraine. They valued a change in reduction in migraine days from 10% to 50% more highly than avoiding the worst AE, but they were nonetheless willing to trade off greater efficacy for less severe AEs. Avoiding problems with memory was more important to the respondents than avoiding problems with thinking, and avoiding a 10% weight gain was more important than avoiding problems with thinking and memory. A once-monthly injection or daily pill was more preferable than a twice-monthly injection. Respondents were willing to pay a mean cost of
- $84 per month to avoid a 10% weight gain (95% CI, $64-$103),
- $59 per month to avoid memory problems (95% CI, $42-$76),
- $35 per month to avoid a 5% weight gain (95% CI, $20-$51), and
- $32 per month to avoid thinking problems (95% CI, $18-$46).
This study was limited by the fact that migraine diagnoses were self-reported and not clinically confirmed. The study sample was drawn from an opt-in survey and may not be representative of the broader population.
In light of the results of this study showing that patients with migraine may be willing to make trade-offs with efficacy and AEs, clinicians should discuss with patients the treatment outcomes that are most important to them when making treatment decisions.
Mansfield C, Gebben DJ, Sutphin J, et al. Patient preferences for preventive migraine treatments: a discrete-choice experiment [published online March 12, 2019]. Headache. doi: 10.1111/head.13498