2023-08-26 10:06:22
Update
August 26, 2023
12:06
Migraine is costly to society. We can fix it with better treatments. But these are expensive and the resources are not endless.
Belgian pole vaulter Ben Broeders is playing his third world championship final this Saturday evening in Budapest. He hopes to compete without headaches. In the previous final in the United States, a migraine attack hampered her performance. Ben Broeders, 28, has suffered from it for several years. He is not the only one.
“In people under 50, migraine is the leading cause of work incapacity.”
Almost a fifth of Belgians suffer from migraine at some point in their life. Some migraine sufferers can suffer more than eight days per month, which often forces them to stop working for one or more days. And when they still manage to “stay on the job”, their productivity suffers. “In people under 50, migraine is the leading cause of work incapacity,” says Professor Koen Paemeleire, neurologist at Ghent University Hospital.
A considerable cost for everyone
The implications for society and business are significant. So, migraines would cause the loss of some 1.65 million working days per year. The social cost is estimated at nearly one billion euros. Just the height of this amount should encourage the authorities to tackle the problem more, believes the Liège neurologist and migraine expert Jean Schoenen. Because migraine, in the opinion of specialists, is insufficiently treated.
The catch is that migraine treatments are often expensive, especially innovative remedies that have emerged in recent years. To make them accessible, the public authorities provide reimbursements, which increase the bill for social security. As demonstrated by the three preventive drugs that have been reimbursed since mid-2021. They aim to inhibit CGRP, a molecule naturally present in the brain, which by dilating the vessels there can lead to a migraine attack.
Such CGRP inhibitors can cost up to 500 euros per month. A cost reduced to around ten euros for those eligible for reimbursement. In 2022, nearly 10,000 patients benefited from it. That is an official cost for the Inami, the federal health insurance body, of 35 million euros, which is already multiply by 14 the cost of migraine for Social Security, compared to expenditure in 2021. In reality, the cost is less, because secret discounts have been imposed on manufacturers.
Refund Restrictions
The bill should continue to soar. “The number of people taking these CGRP inhibitors will only increase, says Koen Paemeleire, because we know that migraine affects a large part of the population and that many people have not been diagnosed.”
A fourth CGRP inhibitor is in the running for recognition by the end of the year. In addition, a dossier was submitted to the Medicines Reimbursement Commission (CRM) at the end of February for Vydura, a first specialty of the latest migraine treatments, known as gepants.
To control costs, social security has introduced restrictions. Not everyone is entitled to reimbursement. CGRP inhibitors are reserved for people who have more than eight migraine days per month and in whom three other preventive treatments – for example blood pressure blockers or anti-epileptic drugs – have failed.
Return effect for the State and for companies
But even with these locks, avoiding a budget slippage will be a headache. “This is always debated with innovative drugs“, remarks Dominique Van Dijck, professor of health economics at UGent. But the resources are not infinite.
The Inami’s drug budget amounted to just under 6 billion euros in 2021. New cancer treatments or drugs such as Katrio, against cystic fibrosis, which costs 15,000 euros per month, make it necessary to ask the following question: how to allocate the budget? And who will finance it?
“The debate about ‘who pays for what in health care’ is hardly conducted among us.”
“The interest of the patient is of course paramount”, emphasizes Dominique Van Dijck. “A sick person loses years of healthy life. But there is also a loss for society. Because this person cannot work, for example. If there is a treatment that effectively remedies this situation, then the question must be asked: who bears what costs? This debate is hardly conducted at the moment.”
Koen Paemeleire stresses that, for the government, tackling migraine does not generate a return effect. “People who are absent from work are not for long periods. They stay at home for one or two days. These costs are therefore borne by the employer..”
“Why not think about a cost-sharing model, between the employer and the State?”, emphasizes Dominique Van Dijck. We should also look critically at existing refunds. And better analyze the behavior of prescribers. It is a difficult debate, but it is necessary.”
The summary
- Migraine is the most common neurological disorder. Hundreds of thousands of Belgians suffer from it chronically.
- The annual cost is estimated at almost one billion euros, mainly due to sick leave.
- New drugs provide relief to migraine sufferers, but their price is high. The Inami saw reimbursement costs explode last year.
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