Cost of medication overuse headache in Italian patients at the time-point of withdrawal: a retrospective study based on real data

The objective was to assess the cost of Medication Overuse Headache (MOH) at the time-point of withdrawal treatment. We implemented a protocol in which both direct and indirect cost were directly gathered from patients and referred to the previous three months. Direct costs were calculated by medications for acute treatment and prophylaxis, diagnostic procedures, visits, complementary treatments, informal care. Indirect costs were referred to missed workdays and workdays with reduced productivity: we asked patients to refer their salaries and to rate the overall level of performance in days worked with reduced productivity, and we calculated indirect costs on this basis. A total of 135 patients were enrolled: direct costs were around 415€/month; indirect costs were 530€/month, and were mostly due to presenteeism (350€, 66.3%) rather than to absenteeism (160€, 33.7%). Our data showed higher cost than those of a previous study: this is likely due to a different approach to cost definition, to the inclusion of direct non-medical cost, and of non-pharmacological treatments.