Migraine Nurses in Primary Care: Costs and Benefits

Objective.-We examined the costs and benefits of introducing migraine nurses into primary care. Background.-Migraine is one of the most costly neurological diseases. Methods.-We analyzed data from our earlier nonrandomized cohort study comparing an intervention group of 141 patients, whose care was supported by nurses trained in migraine management, and a control group of 94 patients receiving usual care. Estimates of per-person direct costs were based on nurses' salaries and referrals to neurologists. Indirect costs were estimated as lost productivity, including numbers of days of absenteeism or with <50% productivity at work due to migraine, and notional costs related to lost days of household activities or days of <50% household productivity. Analysis was conducted from the payer's perspective. Results.-After 9 months the direct costs were (sic)281.11 in the control group against (sic)332.23 in the intervention group (mean difference -51.12; 95% CI: -113.20-15.56; P=.134); the indirect costs were (sic)1985.51 in the control group against (sic)1631.75 in the intervention group (mean difference 353.75; 95% CI: -355.53-1029.82; P=.334); and total costs were (sic)2266.62 in the control group, against (sic)1963.99 in the intervention group (mean difference 302.64; 95% CI: -433.46-1001.27; P=.438). When costs attributable to lost household productivity were included, total costs increased to (sic)6076.62 in the control group and (sic)5048.15 in the intervention group (mean difference 1028.47; 95% CI: -590.26-2603.67; P=.219). Conclusion.-Migraine nurses in primary care seemed in this study to increase practice costs but decrease total societal costs. However, it was a nonrandomized study, and the differences did not reach significance. For policy-makers concerned with headache-service organization and delivery, the important messages are that we found no evidence that nurses increased overall costs, and investment in a definitive study would therefore be worthwhile.