Direct Costs of Preventive Headache Treatments: Comparison of Behavioral and Pharmacologic Approaches

(Headache 2011;51:985‐991) Objectives.— This study provides preliminary data and a framework to facilitate cost comparisons for pharmacologic vs behavioral approaches to headache prophylactic treatment. Background.— There are few empirical demonstrations of cumulative costs for pharmacologic and behavioral headache treatments, and there are no direct comparisons of short‐ and long‐range (5‐year) costs for pharmacologic vs behavioral headache treatments. Methods.— Two separate pilot surveys were distributed to a convenience sample of behavioral specialists and physicians identified from the membership of the American Headache Society. Costs of prototypical regimens for preventive pharmacologic treatment (PPT), clinic‐based behavioral treatment (CBBT), minimal contact behavioral treatment (MCBT), and group behavioral treatment were assessed. Each survey addressed total cost accumulated during treatment (ie, intake, professional fees) excluding costs of acute medications. The total costs of preventive headache therapy by type of treatment were then evaluated and compared over time. Results.— During the initial months of treatment, PPT with inexpensive mediations (3 $/day), preventive drug treatment becomes more expensive than CBBT after the first year. Long‐term, and within year 1, MCBT was found to be the least costly approach to migraine prevention. Conclusions.— Through year 1 of treatment, inexpensive prophylactic medications (such as generically available beta‐blocker or tricyclic antidepressant medications) and behavioral interventions utilizing limited delivery formats (MCBT) are the least costly of the empirically validated interventions. This analysis suggests that, relative to pharmacologic options, limited format behavioral interventions are cost‐competitive in the early phases of treatment and become more cost‐efficient as the years of treatment accrue.