To evaluate direct costs of medical services for migraine patients versus matched controls in a national health coverage system in southern Israel before introduction of monoclonal antibodies targeting calcitonin gene-related peptide pathway.

Migraine is a common disease affecting >1 billion individuals worldwide (GBD 2019 Diseases and Injuries Collaborators.Lancet.2020;396(10258):1204-1222). Introduction of novel, costly therapeutic modalities for migraine focuses attention on costs of migraine patients to health care systems and insurers.

24,355 migraine patients and 46,961 matched controls were analyzed. Average annual direct expenditure per migraine patient was >60% higher than for controls ($1,244 vs $763; p<0.001). Main items of expenditure were PCP visits ($429 vs $240; p<0.001), hospitalizations ($326 vs $242; p<0.001), outpatient diagnostic tests ($180 vs $102; p<0.001), and specialist visits ($178 vs $105; p<0.001). Estimated total annual medical cost for migraine patients was higher than for controls by $481 per patient on average (~$12 million per year for our study population).

In southern Israel, costs of direct medical services for patients with migraine are significantly higher than for individuals without migraine. The cost effectiveness of all new treatment modalities should be evaluated, considering their potential effect in reducing direct medical costs.