Misdiagnosis of Migraine Drives Unnecessary Use of Health Care Resources
A new study compared health care utilization and costs between adults initially misdiagnosed followed by a correct diagnosis of migraine and those whose first diagnosis was accurate.
Among adults who were initially misdiagnosed before receiving a correct diagnosis of migraine, a new study found significantly higher rates of hospital admissions, emergency department (ED) visits, specialist consultations, and prescription fills compared with those whose original diagnosis was correct.1
For the study, researchers compared a cohort of 29,147 adults correctly diagnosed with migraine with 3,841 who were first misdiagnosed. Led by Beth Devine PhD, PharmD, MBA, of the University of Washington CHOICE Institute, Seattle, Washington, the team reported the latter group had increased rates of hospital use including inpatient admissions (0.02 vs 0.01; incidence rate ratio [IRR], 1.61; 95% CI, 1.47–1.74) and ED visits (0.10 vs 0.05; IRR, 1.89; 95% CI, 1.79–1.99).1 The initially misdiagnosed group also used outpatient services at a higher rate, ie, for neurologist visits (0.12 vs 0.02; IRR, 5.95; 95% CI, 5.40–6.57) and non-neurologist clinic visits (2.64 vs 1.58; IRR, 1.67; 95% CI, 1.62–1.72) and also had significantly higher rates of prescription fills (2.82 vs 1.84; IRR, 1.53; 95% CI, 1.48–1.58).1
Study findings were published online in the journal Headache.1
Despite the prevalence of migraine, Devine and colleagues cite studies that show 50% to 80% of initial diagnoses may be incorrect.2 The most common misdiagnoses are sinus headache, stress headache, tension type headache, sinusitis, and cervical pain. (refs) The reasons for the initial error in identifying migraine include limited objective screening tools, inadequate knowledge of migraine among clinicians, poor patient-clinician communication, and late referral to a specialty center.3
The resulting economic burden to the health care system derives from unnecessary testing, multiple consultations, and even unnecessary surgery, eg, sinus procedures, the authors wrote. Theirs is the first study "to characterize the impact of a migraine misdiagnosis on patients’ healthcare resource utilization (HCRU) and costs," they wrote, adding that a literature search surfaced no published claims analysis that examines migraine misdiagnosis."1
Investigators tapped the Marketscan Commercial and Medicare Supplemental Databases to identify adults with incident migraine diagnosed between June 1, 2018, and June 1, 2019, then performed a retrospective search for those originally misdiagnosed, defined as having 1 or more inpatient or 2 or more outpatient medical claims on different dates with a diagnosis of a commonly mistaken condition within the 24 months preceding a confirmed migraine diagnosis.1
The majority of the combined correctly and incorrectly diagnosed participants were women (77-81%) and had commercial insurance. Mean age across cohorts was approximately 40 years. Misdiagnosed participants had a greater proportion of migraine-related comorbidities
Direct health care costs
The researcher reported higher costs related to use of health care for misdiagnosed participants across care settings. Compared with the correctly diagnosed cohort, those who were misdiagnosed accrued increased costs per patient per month (PPPM), including higher inpatient costs of $844 (95% CI, $587–$1,100), ED costs of $124 (95% CI, $97–$151), neurologist costs of $33 (95% CI, $10–$56), non-neurologist outpatient costs of $686 (95% CI, $531–$841), and prescription costs of $90 (95% CI, $2–$178).
Similarly, participants who received multiple misdiagnoses before an accurate diagnosis of migraine had statistically significantly higher rates of health care resource utilization across the same care settings: inpatient admissions (IRR, 1.69; 95% CI, 1.49–1.90), ED visits (IRR, 2.13; 95% CI, 1.96–2.31), neurologist (IRR, 7.76; 95% CI, 6.72–9.00) and non-neurologist outpatient visits (IRR, 1.86; 95% CI, 1.78–1.93), and prescription fills (IRR, 1.60; 95% CI, 1.52–1.69), according to the results.
The study authors emphasized the need for further research to assess the long-term implications of migraine misdiagnosis, including indirect costs such as productivity loss and workday absenteeism. "The long-term impact of misdiagnosis remains an unanswered question. A comprehensive evaluation of indirect costs would help quantify the personal and economic burden of misdiagnosed migraine," they concluded.
