Use of willingness to pay to study values for pharmacotherapies for migraine headache

BACKGROUND. There is a wide range of therapeutic options for migraine headaches, yet little is known about how patients value different treatment alternatives nor how to tailor treatments to patients' preferences. OBJECTIVE. Assess patients' preferences for outcomes of treatment of migraine headache based on their marginal willingness to pay (WTP) for treatment attributes. MATERIALS AND METHODS. In an Internet-based study, we used computer software to measure participants' WTP for a hypothetical ideal drug (one that was 100% effective, worked quickly, and had no adverse effects) and for other hypothetical drugs, each with one "less than ideal" attribute of performance. SUBJECTS. Two hundred fifty-seven self-identified migraineurs recruited via an Internet Web site. RESULTS. A high proportion of participants in the study had symptoms consistent with migraine etiology of headache (99%). Median ''out-of-pocket" monthly WTP cost for an ideal migraine therapy was $130. WTP was associated with participants' own migraine experience: severity of pain, frequency of headaches, and the types of medications used in the past. WTP was reduced when pharmaceuticals offered less benefit, ranging from a mean of 74% of ideal for treatments that failed to relieve nausea, to 43% of ideal in treatments associated with a 50% chance of a rebound headache. CONCLUSIONS. There is wide variability in patients' strength of preference for different attributes of migraine therapy. Choice of therapy for migraine headache should be individualized based on patients' preferences. WTP measures appear to be a valid and feasible metric for quantifying treatment preferences for migraine therapies.