Trajectory of health care resources among adults stopping or reducing treatment frequency of botulinum toxin for chronic migraine treatment in Alberta, Canada.

Objective: Understand health resource, medication use, and cost of adults with chronic migraine who received guideline‐recommended onabotulinumtoxinA (botulinum toxin) treatment frequency and then continued or reduced/stopped. Background: Botulinum toxin may be a beneficial treatment for chronic migraine; the trajectory of health resources utilization among those with continued or reduced/stopped use is unclear. Methods: A retrospective population‐based cohort study utilizing administrative data from Alberta, Canada (2012–2020), was performed. A cohort of adults who received ≥5 botulinum toxin treatment cycles for chronic migraine over 18 months (6‐month run‐in; 1‐year pre‐index period) were grouped into those who (1) continued use (≥3 treatments/year), or (2) stopped or reduced use (stopped for 6 months then received 0 or 1–2 treatments/year, respectively) over a 1‐year post‐index period. Health resources and medication use were described, and pre–post costs were assessed. A second cohort that received ≥3 treatments/year immediately followed by 1 year of stopped or reduced use was considered in sensitivity analysis. Results: Pre–post health resource, medication use, and costs were similar among those with continued use (n = 3336). Among those who stopped or reduced use (n = 1099; 756 stopped, 343 reduced), health resource, medication use, and costs were lower in the post‐ (total median per‐person cost [IQR]: all‐cause $4851 [$8090]; migraine‐related $835 [$1915]) versus pre‐ (all‐cause $6096 [$7207]; migraine‐related $2995 [$1950]) index period (estimated cost ratios [95% CI]: total all‐cause 0.86 [0.79, 0.95]; total migraine‐related 0.44 [0.40, 0.48]). In the second cohort (n = 3763), return to continued use (≥3 treatments/year) occurred in up to 70.4% in those with reduced use. Conclusions: Of adults treated with botulinum toxin for chronic migraine, 75.2% had continued use, stable health resource and medication use, and costs over a 2 year period. In those that stopped/reduced use, the observed lower health resource and migraine medication use may indicate improved symptom control, but the resumption of guideline‐recommended treatment intervals after reduced use was common. [ABSTRACT FROM AUTHOR]