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. 2021 Aug 23;22(1):99. doi: 10.1186/s10194-021-01310-x

Table 3.

Treatment uptake, use of resources and lost productivity according to treatment management plan (Spain)

Headache type Current care (%) Target care (%) Notes
Uptake (including coverage and adherence) Migraine 88.6 94.3

Current care: 54.5% migraine non-specific + 20.4% migraine specific + 13.7% migraine prophylaxis = 88.6% (see treatment plan below)

Target care: We assumed that structured services with consumer education and provider training enhances coverage and adherence so that uptake is increased by 50% of current deficit: medicines uptake = [{100% - 88.6%}/2] + 88.6%) = 94.3%

TTH 69.6 84.8

Current care: 69.6% acute medications; 0% TTH prophylaxis (see treatment plan below)

Target care: We assumed as above: medicines uptake [{100% - 69.6%}/2] + 69.6%) = 84.8%

MOH 0 50.0

Current care: 0% treated

Target care: We assumed that structured services with consumer education and provider training enhances treatment coverage and adherence so that proportion withdrawn from medicines overuse is increased by 50% of current deficit: withdrawal = [{100–0%}/2] + 0%) = 50.0%

TREATMENT PLAN
 A. Acute management (non-specific drugs)
  Simple analgesics (eg, ASA 1 g) Migraine 54.5 47.2

Current care: from Eurolight data [20]

Target care: With provider training, treatment with simple analgesics alone is offered to 50% (expert assumption), with uptake = 47.2% (50% of 94.3%)

TTH 69.6 82.3

Current care: from Eurolight data [20]

Target care: With provider training, treatment with simple analgesics alone is offered to 97% (expert assumption), with uptake = 82.3% (97% of 84.8%)

MOH 0 0 Not applicable to MOH care
 B. Acute management (specific drugs)
  Sumatriptan 50 mg Migraine 20.4 0

Current care: from Eurolight data [20]

Target care: With provider training, treatment with specific drugs alone is offered to 0% (expert assumption)

TTH 0 0 Not applicable to TTH care
MOH 0 0 Not applicable to MOH care
 C. Acute stepped care management
  ASA 1 g + sumatriptan 50 mg Migraine 0 18.9

Current care: not included in current care

Target care: With provider training, acute stepped-care management is offered to 20% (expert assumption), with uptake = 18.9% (20% of 94.3%)

TTH 0 0 Not applicable to TTH care
MOH 0 0 Not applicable to MOH care
 D. Prophylaxis + acute management
  Amitriptyline 100 mg/day + ASA 1 g + sumatriptan 50 mg Migraine 13.7 28.3

Current care: from Eurolight data [20]

Target care: With provider training, prophylaxis + acute stepped-care management is offered to 30% (expert assumption), with uptake = 28.3% (30% of 94.3%)

TTH 0 2.5

Current care: not included in current care

Target care: With provider training, prophylaxis + acute care management is offered to 3% (expert assumption), with uptake = 2.5% (3% of 84.8%)

MOH 0 0 Not applicable to MOH care
Consultations and investigations
 Doctor visits (year 1) Migraine 25.1 50.0

Current care: 25.1% with migraine had seen a doctor (Eurolight data [20]), of whom 19.3% had seen a GP and 5.8% a specialist. We assumed 2 visits in either case.

Target care: With consumer education, 50% see a doctor (expert assumption based on estimated need for professional care).

Note that in the model those who see a specialist would see a GP first.

TTH 9.4 2.25

Current care: 9.4% with TTH had seen a doctor (Eurolight data [20]), of whom 6.9% had seen a GP and 2.5% a specialist. We assumed 2 visits in either case.

Target care: With consumer education, 3% (Stovner 2007 [21]) ×  75% = 2.25% see a specialist and none see a GP (expert assumption based on estimated need for professional care).

Note that those who see a specialist would see a GP first.

MOH 51.2 100

Current care: 51.2% with MOH had seen a doctor (Eurolight data [20]), of whom 21.6% had seen a GP and 29.6% a specialist. We assumed 2 visits in either case.

Target care: With consumer education, 100% see a doctor (expert assumption based on estimated need for professional care).

Note that those who see a specialist would see a GP first.

 GP visits Migraine 19.3 45.0

Current care: 19.3% had seen a GP (Eurolight data [20])

Target care: With consumer education, 45.0% (90% of 50%) see a GP (we assumed 2 visits in a year)

TTH 6.9 0

Current care: 6.9% had seen a GP (2 times in a year) (Eurolight data [20])

Target care: Chronic TTH is difficult to treat, so we assumed that all should go to levels 2 or 3 (ie, “specialists”).

Note that those who see a specialist would see a GP first.

MOH 21.6 100

Current care: 21.6% had seen a GP (2 times in a year) (Eurolight data [20])

Target care: With consumer education, 100% see a GP (we assumed 2 visits in a year)

 Specialist visits Migraine 5.8 5.0

Current care: 5.8% had seen a specialist (2 times in a year)

Target care: With consumer education and provider training, 5.0% (10% of 50%) see a specialist (we assumed 2 visits in a year)

TTH 2.5 2.25

Current care: 2.5% had seen a specialist (2 times in a year)

Target care: With consumer education and provider training, 2.25% see a specialist (we assumed 2 visits in a year)

MOH 29.6 100

Current care: 29.6% saw a GP (2 times in a year)

Target care: With consumer education and provider training, 100% see a specialist (we assumed 2 visits in a year)

 Investigations (MRI) (year one) Migraine 8.5 1.0

Current care: All those seeing a specialist had MRI (one in a year)

Target care: With provider training, we assumed 1% have MRI (one in a year)

TTH 1.0 0.5

Current care: 1% had an MRI

Target care: We assumed 0.5% have MRI examination (one in a year) – half the current estimate

MOH 0 0

Current care: Nobody had an MRI

Target care: Nobody has an MRI

 Doctor visits (years 2–5) Migraine 24.6 50.0

Current care: 24.6% with migraine had seen a doctor (Eurolight data [20]), of whom all saw a GP only after year 1. We assumed 2 visits per year.

Target care: With consumer education, 50% see a doctor (expert assumption based on estimated need for professional care)

TTH 9.4 2.25

Current care: 9.4% with TTH had seen a doctor (Eurolight data [20]), of whom all saw a GP only after year 1. We assumed 2 visits per year.

Target care: With consumer education, 3% (Stovner 2007 [21]) × 75% = 2.25% see a doctor (expert assumption based on estimated need for professional care).

Note that those who see a specialist would see a GP first.

MOH 51.2 100

Current care: 51.2% with MOH had seen a doctor (Eurolight data [20]), of whom all saw a GP only after year 1. We assumed 2 visits per year.

Target care: With consumer education, 100% see a doctor

 GP visits Migraine 24.6 50.0

Current care: 24.6% saw a GP. We assumed 2 visits each year.

Target care: With consumer education, 50% see a GP. We assumed 2 visits each year.

TTH 9.4 0

Current care: 9.4% saw a GP. We assumed 2 visits each year.

Target care: Chronic TTH is difficult to treat, so we assumed that all should go to levels 2 or 3 (ie, “specialists”).

Note that those who see a specialist would see a GP first.

MOH 51.2 100

Current care: 51.2% saw a GP. We assumed 2 visits each year.

Target care: With consumer education, 100% see a GP. We assumed 2 visits each year.

 Specialist visits Migraine 0 0

Current care: No visits after year 1

Target care: No visits after year 1

TTH 0 2.25

Current care: No visits after year 1

Target care: With consumer education and provider training, 2.25% see a specialist (we assumed 2 visits in a year).

MOH 0 0

Current care: No visits after year 1

Target care: No visits after year 1

 Investigation (MRI) (years 2–5) Migraine 0 0

Current care: nobody had an MRI after year 1

Target care: nobody had an MRI after year 1

TTH 0 0

Current care: nobody had an MRI after year 1

Target care: nobody had an MRI after year 1

MOH 0 0

Current care: nobody had an MRI after year 1

Target care: nobody had an MRI after year 1

 Lost productivity We assumed that lost work productivity is correlated with disease-related disability, and reduced disability would bring reduced lost productivity. In our baseline scenario, all lost productivity was explained by disease-related disability.
 Days lost from work in 12 months Migraine 7.6 2.4

Current care: based on Eurolight data [16]

Target care: we assumed 69% decrease in lost productivity (equal to the gain in HLYs reported for migraine (see Table 4)): 7.6-(7.6*0.69) = 2.4 days

TTH 3.2 0.8

Current care: based on Eurolight data [16]

Target care: we assumed 76% decrease in lost productivity (equal to the gain in HLYs reported for TTH (see Table 4)): 3.2-(3.2*0.76) = 0.8 days

MOH 22.8

7.1 (if revert to migraine);

5.5 (if revert to TTH)

Current care: based on Eurolight data [16]

Target care:

for individuals reverting to migraine, we assumed 69% decrease in lost productivity (equal to the gain in HLYs reported for migraine (see Table 4)): 22.8-(22.8*0.69) = 7.1 days

for individuals reverting to TTH, we assumed 76% decrease in lost productivity (equal to the gain in HLYs reported for TTH (see Table 4)): 22.8-(22.8*0.76) = 5.5 days