To analyze and compare direct annual healthcare expenditure on diseases with high disability, including migraine, across four countries: the United States of America (USA), Canada, Germany, and the Netherlands.

Migraine is under-recognized, under-diagnosed, and under-treated worldwide. Indeed the scale of the under-treatment of headache disorders prompted the World Health Organization in 2011 to write to the world’s Ministries of Health to “illuminate the worldwide neglect of a major public-health problem, and reveal the inadequacies of responses to it”.

Diseases associated with high disability were identified from the Global Burden of Disease 2016 study for each country. Five common diseases with high disability across all four countries where healthcare expenditure data were also available, were included in this analysis. Cost data per disease were sourced from a published study for the USA and government websites for remaining countries. All the cost estimates were converted to US dollars and were adjusted to year 2016.

Five diseases identified as high disability burden included osteoarthritis, diabetes mellitus, skin and subcutaneous diseases, anxiety disorders, and migraine. Despite its high disability burden, expenditure on migraine was consistently the lowest across four countries and constituted less than 0.5% of total direct annual healthcare expenditure. Comparatively, healthcare expenditure on diabetes was 14-times as that of migraine in the USA, 7-times in Canada, 16-times in Germany and 37-times in the Netherlands, even though the disability burden for diabetes was similar or lower than migraine.

Despite its high burden, societies significantly under-invest in migraine and such under-investment may be correlated with major gaps in the real-world migraine management. Literature suggests that better-quality care leads to improved outcomes for patients with migraine. Further research is needed to expand this analysis to other countries and to seek possible solutions on how improved care can be made accessible to broader patient populations.