Value of Treatment Report 2017
The Value of Treatment research project draws from the European Brain Council (EBC) Report “The Economic Cost of Brain Disorders in Europe” published in 2005 (Balak and Elmaci 2007) and updated in 2010 (Gustavsson et al. 2011) that provided a solid estimation on the economic costs of brain disorders in Europe. The indirect costs of brain disorders make up for 40 percent of the total costs – which EBC estimated at around 800 billion euros per year in Europe.The Value of Treatment Research Project will ultimately provide evidence-based and cost-effective policy recommendations for the adoption and implementation of a more patient-centred and sustainable coordinated care model for brain disorders. June 2017, marked the release of the findings of the quantitative research phase 2 of the project with case studies analyses of the key brain disorders throughout Europe. The key findings from the initial Headache Case Study of the VOT project are as follows :
- From the various types of headache disorders identified, Migraine, Tension Type Headache (TTH) and Medication Overuse Headache (MOH) are the most common and burdensome, from a public health perspective.
- TTH and migraine are the second and third most common diseases in the world, estimated to affect 22% and 15% of adults respectively, while MOH affects 2-3% of adults.
- Each million of the population in Europe loses an estimated 400,000 lost days from work or school every year to migraine alone and the estimated cost of headache disorders in Europe is well in excess of €100 billion per year
- Headache disorders are under-recognized in society, under-prioritized in health policy, under-diagnosed in the population and under treated in health-care systems. People with headache fail to seek health care that is inadequate, and adhere poorly to it.
- The Care Pathway for most European people with headache is a series of dead ends.
- It recommends that the most appropriate setting for the treatment of headache is in the primary care setting and that specialist migraine clinics be dedicated to the treatment of a minority who suffer chronic headache and migraine, when all primary care treatment options have been exhausted.
- Despite the recognition of the importance of the primary care setting for treating headache, there is knowledge gap among health-care providers and worldwide only four hours are committed to headache disorders in formal undergraduate medical training lasting 4-6 years.
- Headache disorders are not perceived by the public as serious as they do not cause death and are not contagious. Consequently, headaches are often trivialized as “normal” and seen in those who complain of them as merely an excuse to avoid responsibility.
- On a political level, many governments, even if aware of it, do not acknowledge the substantial burden of headache on society. Health care for headache obviously comes at a cost: large numbers of people need treatments, together with advice on correct usage of these treatments and these all place a burden on pubic healthcare providers.
The recommendation of the study are as follows:
- Headache services should be based in primary care to provide sufficient reach and have to be supported by specialist care.
- People that reach specialist care are only be those that fail in controlling headaches with primary care indications or that are at risk of developing MOH. Correct management in the primary care setting will ease the burden on these specialist clinics which are currently facing huge waiting lists and over subscription.
- Pharmacists have a key role in advising on use of over-the-counter (OTC) and other drugs, discouraging overuse and on the use of headache services.
- Educational initiatives are needed: aimed at health-care providers to improve competence at their respective levels, so to reduce the under diagnosis of headache disorders, and at the public to promote self-care and effective use of headache services.
The University of Copenhagen has in cooperation with the Danish Headache Center, developed a professional Masters programme in Headache Disorders for healthcare professionals and you can read more about that programme and other MAI Health Professional Training Events here.
All published findings and documents, including case studies for the other key brain disorders can be accessed from the ECB website here.
To view the Headache Case Study summary poster click here.