Willingness to pay methods measure treatment preferences and also measure the burden of illness in economic terms. We used a contingent valuation method to measure migraine sufferers’ willingness to pay (WTP) for acu...Willingness to pay methods measure treatment preferences and also measure the burden of illness in economic terms. We used a contingent valuation method to measure migraine sufferers’ willingness to pay (WTP) for acute medication for their most severe headache attacks, based on various profiles of treatment benefits and the characteristics of the migraine sufferer. Subjects were identified from a population- based database of migraine sufferers, previously recruited by random digit dialling. Telephone interviews (n = 1428) were used to gather demographic and headache characteristics. Subjects who met the International Headache Society criteria for migraine with or without aura and satisfied the other inclusion criteria based on telephone interview (n = 312) were invited to participate in a mailed questionnaire study. The questionnaire was mailed to the 310 subjects who agreed to participate and 201 (65% )- surveys were returned. The survey included questions on the demographics, the migraine characteristics, and the psychological disposition of the respondents. WTP for an acute migraine treatment with 14 different hypothetical treatment profiles was explored. Responders and non- responders to the survey were generally similar. The newly designed WTP questionnaire had high internal consistency (Cronbach’ s α 0.90) and test- retest reliability (Spearman’ s correlation coefficients 0.71- 0.77). Study subjects were willing to pay a median price of ＄ 5 for a migraine treatment that provided complete relief in 30 min and worked 100% of the time, with no side- effects and no headache recurrence. Median WTP decreased as treatment attributes deviated from this ideal. For example, WTP declined to a median of ＄ 1 for complete relief in 2 h and to ＄ 0.25 for complete relief in 4 h. All of the medication attributes powerfully influenced WTP. Several variables predicted WTP including current payment for medication, MIDAS (Grade III), and those with headaches of long duration. Subjects who employed a greater number of coping skills were less willing to pay. Patient demographics and migraine severity predict WTP, but treatment attributes were also important. As treatment improves, WTP for migraine medications is likely to increase.展开更多
Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, conta...Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, contact points may be associ ated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and rad iographic evidence of contact points in the sinonasal area. We reviewed charts o f patients who underwent endoscopic sinus surgery and septoplasty for contact po int in the same surgical facility, from October 1998 through August 2003. Subjec ts eligible for surgery had: (i) refractory migraine (failed to standard pharmac ological headache treatments) or refractory transformed migraine; (ii) contact p oints demonstrated by computed tomography scan; (iii) reported significant heada che improvement after topical anaesthesia to the contact area. Headache characte ristics were assessed preoperatively and at follow-up (6-62 months after surge ry) using a standardized questionnaire. A total of 21 subjects (72.5%women) wer e assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days p er month (P=0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-1 0 scale (P=0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P < 0.0001). A total of 16 subjects (76.2%) had their headache scores improved by 50%or more; nine (42.9%) were pain free at the last follow -up. A total of 18 (95.8%) had at least a 25%reduction in their headache scor es. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, a nd positive response after topical anaesthesia, surgical approach toward the tri ggering factor may be useful. Prospective studies are necessary to confirm our r esults.展开更多
Objective: To evaluate the clinical efficacy of a standardized special root e xtract from the plant Petasites hybridus as a preventive therapy for migraine. M ethods: This is a three-arm, parallel-group, randomized tr...Objective: To evaluate the clinical efficacy of a standardized special root e xtract from the plant Petasites hybridus as a preventive therapy for migraine. M ethods: This is a three-arm, parallel-group, randomized trial comparing Peta sites extract 75 mg bid, Petasites extract 50 mg bid, or placebo bid in 245 pati ents with migraine. Eligible patients met International Headache Society criteri a for migraine, were ages 18 to 65, and had at least two to six attacks per mont h over the preceding 3 months. The main outcome measure was the decrease in migr aine attack frequency per month calculated as percentage change from baseline ov er a 4-month treatment period. Results: Over 4 months of treatment, in the per -protocol analysis, migraine attack frequency was reduced by 48% for Petasit es extract 75 mg bid (p = 0.0012 vs placebo), 36% for Petasites extract 50 mg bid (p = 0.127 vs placebo), and 26% for the placebo group. The proportion of p atients with a ≥ 50% reduction in attack frequency after 4 months was 68% f or patients in the Petasites extract 75-mg arm and 49% for the placebo arm ( p < 0.05). Results were also significant in favor of Petasites 75 mg at 1, 2, an d 3 months based on this endpoint. The most frequently reported adverse reaction s considered possibly related to treatment were mild gastrointestinal events, pr edominantly burping. Conclusions: Petasites extract 75 mg bid is more effective than placebo and is well tolerated as a preventive therapy for migraine. Petasit es 50 mg PO bid was not significantly more effective than placebo on the primary study endpoints.展开更多
文摘Willingness to pay methods measure treatment preferences and also measure the burden of illness in economic terms. We used a contingent valuation method to measure migraine sufferers’ willingness to pay (WTP) for acute medication for their most severe headache attacks, based on various profiles of treatment benefits and the characteristics of the migraine sufferer. Subjects were identified from a population- based database of migraine sufferers, previously recruited by random digit dialling. Telephone interviews (n = 1428) were used to gather demographic and headache characteristics. Subjects who met the International Headache Society criteria for migraine with or without aura and satisfied the other inclusion criteria based on telephone interview (n = 312) were invited to participate in a mailed questionnaire study. The questionnaire was mailed to the 310 subjects who agreed to participate and 201 (65% )- surveys were returned. The survey included questions on the demographics, the migraine characteristics, and the psychological disposition of the respondents. WTP for an acute migraine treatment with 14 different hypothetical treatment profiles was explored. Responders and non- responders to the survey were generally similar. The newly designed WTP questionnaire had high internal consistency (Cronbach’ s α 0.90) and test- retest reliability (Spearman’ s correlation coefficients 0.71- 0.77). Study subjects were willing to pay a median price of ＄ 5 for a migraine treatment that provided complete relief in 30 min and worked 100% of the time, with no side- effects and no headache recurrence. Median WTP decreased as treatment attributes deviated from this ideal. For example, WTP declined to a median of ＄ 1 for complete relief in 2 h and to ＄ 0.25 for complete relief in 4 h. All of the medication attributes powerfully influenced WTP. Several variables predicted WTP including current payment for medication, MIDAS (Grade III), and those with headaches of long duration. Subjects who employed a greater number of coping skills were less willing to pay. Patient demographics and migraine severity predict WTP, but treatment attributes were also important. As treatment improves, WTP for migraine medications is likely to increase.
文摘Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, contact points may be associ ated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and rad iographic evidence of contact points in the sinonasal area. We reviewed charts o f patients who underwent endoscopic sinus surgery and septoplasty for contact po int in the same surgical facility, from October 1998 through August 2003. Subjec ts eligible for surgery had: (i) refractory migraine (failed to standard pharmac ological headache treatments) or refractory transformed migraine; (ii) contact p oints demonstrated by computed tomography scan; (iii) reported significant heada che improvement after topical anaesthesia to the contact area. Headache characte ristics were assessed preoperatively and at follow-up (6-62 months after surge ry) using a standardized questionnaire. A total of 21 subjects (72.5%women) wer e assessed. Mean headache frequency was reduced from 17.7 to 7.7 headache days p er month (P=0.003). Mean headache severity was reduced from 7.8 to 3.6 on a 0-1 0 scale (P=0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P < 0.0001). A total of 16 subjects (76.2%) had their headache scores improved by 50%or more; nine (42.9%) were pain free at the last follow -up. A total of 18 (95.8%) had at least a 25%reduction in their headache scor es. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, a nd positive response after topical anaesthesia, surgical approach toward the tri ggering factor may be useful. Prospective studies are necessary to confirm our r esults.
文摘Objective: To evaluate the clinical efficacy of a standardized special root e xtract from the plant Petasites hybridus as a preventive therapy for migraine. M ethods: This is a three-arm, parallel-group, randomized trial comparing Peta sites extract 75 mg bid, Petasites extract 50 mg bid, or placebo bid in 245 pati ents with migraine. Eligible patients met International Headache Society criteri a for migraine, were ages 18 to 65, and had at least two to six attacks per mont h over the preceding 3 months. The main outcome measure was the decrease in migr aine attack frequency per month calculated as percentage change from baseline ov er a 4-month treatment period. Results: Over 4 months of treatment, in the per -protocol analysis, migraine attack frequency was reduced by 48% for Petasit es extract 75 mg bid (p = 0.0012 vs placebo), 36% for Petasites extract 50 mg bid (p = 0.127 vs placebo), and 26% for the placebo group. The proportion of p atients with a ≥ 50% reduction in attack frequency after 4 months was 68% f or patients in the Petasites extract 75-mg arm and 49% for the placebo arm ( p < 0.05). Results were also significant in favor of Petasites 75 mg at 1, 2, an d 3 months based on this endpoint. The most frequently reported adverse reaction s considered possibly related to treatment were mild gastrointestinal events, pr edominantly burping. Conclusions: Petasites extract 75 mg bid is more effective than placebo and is well tolerated as a preventive therapy for migraine. Petasit es 50 mg PO bid was not significantly more effective than placebo on the primary study endpoints.
