LAUSR

BACKGROUND Common treatment for chronic migraine headaches include injection of corticosteroid and anesthetic agents at local trigger sites. However, the effects of therapy are short-term and lifelong treatment is often necessary. In contrast, surgical decompression of migraine trigger sites accomplishes the same goal yet demonstrates successful long-term elimination of chronic migraines. OBJECTIVES Analysis is necessary to determine the complex interplay between the quality of life conferred to patients and cost of the available treatment options for chronic migraine disorders. As such, our primary objective was to perform a cost-utility analysis to determine which patients would benefit most from available treatment options in a cost-conscious model. METHODS A cost-utility analysis was performed in consideration of costs, probabilities, and health state utility scores of opposing interventions. RESULTS Injection therapy offered a minor incremental benefit in quality-adjusted life-years greater than surgical decompression (QALY Δ = 0.6). However, long-term injection therapy was significantly costlier to society than surgical decompression, with treatment estimated at $106,887.96 greater than the cost of surgery. The results of our cost-utility analysis thus conferred a positive ICUR of $178,163.27 in favor of surgical decompression. CONCLUSIONS Surgery provides a durable intervention and has been shown in this study to be extremely cost-effective despite a very minor QALY deficit in comparison to injection therapy. If patients are identified that require treatment in the form of injections for less than 8.25 years, they may fall into a group that should not be offered surgery.