In a recent article in the journal *Health Economics & Quality Management*, a team of headache experts and health economists analyzes the potential economic benefits of self-medication for the German statutory health insurance system (GKV), using migraine and other headaches as examples. Epidemiologically, migraine and other forms of headache are among the most common and, after dementia and stroke, the third most expensive diseases of the nervous system. They are one of the most frequent reasons for doctor visits and emergency room admissions, and can lead to serious disabilities and complications. Worldwide, more than 46% of the adult population suffers from an active headache disorder, 11% from migraine, 42% from tension-type headaches, and 3% from persistent daily headaches. In the World Health Organization's (WHO) ranking of the most disabling diseases, headaches rank 10th for both sexes and 5th for women.

Summarizing data on the one-year prevalence of headaches in adulthood across Europe, 51% suffer from headaches, 14% from migraines, and 4% from chronic headaches (i.e., present on more than 15 days per month). Headaches are particularly detrimental to the productive years of life between the ages of 20 and 60. Health economic studies show that more than 15% of adults were unable to work due to headaches in the past year. In the European Union, headaches in adults aged 18-65 cause annual costs of €173 billion. Comparable epidemiological data are available for Germany.

Today, over 363 different primary diagnoses of headaches are distinguished. These headache disorders can vary greatly in severity. A causal treatment for most types of headaches is not currently possible; however, various symptomatic therapies are available. These include preventative and acute treatment of headache attacks. Seven different triptans are currently available as the drugs of choice for the acute treatment of migraine. Non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid and other non-opioid analgesics, are used in the acute treatment of both migraine and tension-type headaches.

Self-medication for headaches is the most common form of acute treatment. Around 91% of migraine patients and 90% of patients with tension-type headaches use painkillers as part of self-medication, often without further treatment or medical advice. Headaches, as a widespread ailment with significant direct and indirect costs, are highly relevant not only for the individual sufferer but also for society and the statutory health insurance system. The potential role of self-medication in reducing healthcare costs has not yet been investigated, even though self-medication for headaches is well-established worldwide and satisfaction with over-the-counter medications is high.

The authors have, for the first time in an empirical study, analyzed the potential economic benefits of self-medication for statutory health insurance in Germany, using migraines and headaches as examples. The economic aspects under investigation are limited to direct costs, i.e., the costs of medical treatment and the costs of prescription drugs.

The analysis is based on a representative survey of individuals with statutory health insurance regarding the frequency, symptoms, and behavior associated with migraines and headaches. The additional volume of lump-sum payments generated by doctor visits due to headaches and migraines, as well as the expected prescription costs if self-medication were eliminated, were determined. The conditions for billing medical services and prescriptions that were valid in 2013/2014 were taken into account.

The elimination of self-medication would result in additional annual costs for doctor visits of up to €696.8 million without consultation fees, and up to €832.9 million including consultation fees. Taking into account the eliminated costs, the net additional costs for doctors' fees would amount to up to €707.8 million. In addition, there would be annual prescription costs of up to €393.2 million. Self-medication for migraines and headaches would lead to maximum annual savings for statutory health insurance funds of between €964.9 million and €1,101.0 million through unprescribed medications and avoided doctor visits.

Professor Hartmut Göbel, lead author of the study and head physician of the Kiel Pain Clinic , stated that self-medication in cases of misuse or overuse can also lead to complications and additional costs. "However, misuse, overuse, and complications can also occur when medications are prescribed. According to a recent analysis, the most common drug classes that cause overuse headaches are opioids, combination analgesics with psychotropic components, and triptans. Since prescription drug classes are frequently the trigger for overuse headaches, the elimination of self-medication could result in further costs due to misuse and overuse."

This study was the first to examine the health economic impact of self-medication in the treatment of migraines and headaches. A large proportion of those affected treat migraines and headaches outside of the statutory health insurance system using over-the-counter medications. Under the defined conditions, self-medication of migraines and headaches results in annual savings of approximately €1 billion for the statutory health insurance system, saves patients time and travel by avoiding doctor visits, and stabilizes the care of other illnesses by relieving the burden on medical practices. Self-medication of migraines and headaches thus offers significant health economic benefits for the insured population.

Source:

Göbel H, Braun J, Petersen-Braun M, Gessner U. Pharmacoeconomic benefits of self-medication in Germany – Empirical study using the example of migraine and headaches. Gesundh ökon Qual manag, DOI: 10.1055/s-0035-1553042, Publication date: June 1, 2015 (eFirst)

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