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ANTHONY L. FELIU, PH .D., is Analytic Developer, PharMetrics, Inc., a unit of IMS, Watertown, MA. MARCIA F. T. RUPNOW, PH .D., is Director, Outcomes Research (Neurology), Ortho-McNeil Janssen Scientific Affairs, LLC, Titusville, NJ. ANGELA BLOUNT, M.P.H., is Pharmacoepidemiologist, Product Safety and Pharmacovigilance, Astellas Pharma US, Inc., Deerfield, IL; at the time of the study she was Research Consultant, Phar-Metrics, Inc. STEPHEN J. BOCCUZZI, PH .D., M.B.A., is Vice President and Chief Scientific Officer, Phar- Metrics, Inc. JAMES VERMILYEA, PH .D., M.B.A., is Director of Business Development, Outcomes-Insight Consulting, QualityMetric, Inc., Lincoln, RI; at the time of the study he was Research Consultant, PharMetrics, Inc.

Address correspondence to Dr. Feliu at PharMetrics, Inc., 311 Arsenal Street, Watertown, MA 02472 (afeliu{at}pharmetrics.com).

Purpose. The effect of topiramate prophylaxis on medication use and medical resource use for migraine patients was studied. Methods. Medical and pharmacy claims from a commercially insured population were analyzed from July 1, 1999, to March 31, 2004. The study sample included patients with at least one physician encounter or facility claim with a diagnosis of migraine at any point during the study’s time frame. Patients either were naive to drugs labeled for migraine prophylaxis or had switched to topiramate from another drug labeled for migraine prophylaxis. The date of topiramate initiation was between January 1, 2000, and September 30, 2003; topiramate initiation was the index date. Demographic and clinical characteristics were evaluated. Migraine-related medication use and resource use were compared between the pre- and postindex periods. Results. Of the 1749 patients analyzed, 90.2% were female. Neurologists wrote 54% of the index prescriptions. The mean ± S.D. topiramate dosage was 98 ± 65 mg/day. Statistically significant decreases occurred in the proportion of patients using drugs not labeled for migraine prophylaxis, nonopioid analgesics, nonsteroidal antiinflammatory drugs, and headache and migraine relief medications (p < 0.05). There was a 44.9% reduction in emergency room services, 53.2% reduction in migraine- related diagnostic procedures, and 57.1% reduction in migraine-related hospitalization days. Encounter claims for physicians’ office visits did not change significantly. Conclusion. Migraine patients within commercially insured health plans incurred substantial resource use. Within six months following initiation of topiramate preventive therapy, reductions in acute migraine medication and medical resource use were observed among this population of migraine sufferers. Index terms: Analgesics and antipyretics; Anticonvulsants; Antiinflammatory agents; Dosage; Health care; Hospitals; Migraine; Topiramate