Singapore’s billion dollar headache
Migraine patients cost Singapore SGD $1.04 billion worth of economic loss in 2018, including direct costs (healthcare fees) and indirect costs (loss in productivity).
SINGAPORE | 18 September 2019
Burdened with heavy workloads, high levels of stress and lack of work-life balance, Singaporeans are constantly trying to outperform their peers in a bid to stay ahead of the curve. However, more often than not, efforts to do so become counterproductive when immense stress sets off wave after wave of debilitating, throbbing pain in one’s head, accompanied by nausea, blurring of vision, and light and sound sensitivities. To the outsider, migraines are just a more severe form of a headache, something that can be alleviated with an ice pack or a five minute nap on the job, when it really is so much more than that.
Migraine is a chronic condition with episodic attacks. The acute migraine attack is characterised by a severe pulsing sensation, usually on one side of the head, as well as pain, nausea, vomiting, sensitivities to light and sound and in some cases, visual disturbances. Impacts of the illness persists even after the acute attack – at the psychological level, an individual who suffers from migraine has five times the risk of developing migraine due to disruptions at work, in school, and in social roles.
Apart from the functional and emotional burden that migraine places on the individual, a study titled ‘Economic Burden of Migraine in Singapore’ by DUKE-NUS Medical School and Novartis revealed that migraine places a substantial economic burden on Singapore. In 2018 alone, migraine cost the city SGD$1.04 billion in direct costs, namely healthcare fees, and indirect costs – decline in productivity and missed workdays. In general, the estimated indirect costs of migraine are substantial and are much higher than estimates of direct costs. On average, work losses related to reduced productivity are higher than those related to work absence.
The study was conducted based on an online survey completed by 606 migraine patients living in Singapore. The migraine patients were split into two groups, one of which consisted of patients who suffered from what was referred to as ‘lower end episodic migraine’, where patients experienced 3 or less migraine days per month. The other group consisted of patients who suffered from what was referred to as ‘upper end episodic migraine’, where patients experienced up to 14 migraine days per month. The study showed that the per capital costs incurred in 2018 for lower end and upper end episodic migraine group was SGD $5,040 and SGD $14,860 respectively.
The study revealed that four fifths of the total estimated cost was due to a loss of productivity, while the remaining one fifth can be attributed to medical costs. While healthcare costs did not comprise of the majority of the spending fee, the research team analysed the spending pattern of the patients, which revealed that medical tests were the highest source of expenditure, followed by alternative medications and consultations, and deduced that there is a need for more accurate diagnosis for migraine and more effective treatments for migraine patients.
“Our results show that the impact of migraine goes beyond the individual. While it significantly affects the patient’s quality of life, it can also have a substantial economic impact on their work life and, as a result, the wider economy, as people with migraine may take medical leave or miss work due to an episode. If they go to work, they have decreased productivity levels,” Said Dr Eric Finkelstein, Professor at the Health Services and Systems Research Programme at the Duke-NUS Medical School, and co-author of the study.
The results of the study show that respondents missed an average of 9.8 days of work a year due to migraine. For those who were present at work, the effects of migraine significantly lowered their efficiency at work, causing losses in productivity time of about 7.4 days a year.
In Singapore, migraine affects the lives of one in ten people. Even more worryingly, the study also shown that approximately one in four patients in Singapore choose to suffer in silence and carry on with their daily lives instead of seeking medical treatment for their migraine. For those who do try to manage the condition, they usually resort to acute medications that only serve to suppress the symptoms of migraine in the short term. This form of treatment is ineffective and only adds on to their economic loss.
“Given the cost and productivity losses, the study indicates that the current coping strategies adopted by patients are ineffective. Public and private organisations and employers must explore options together, in order to help patients cope better with the symptoms,” Celine Landie, managing director of Novartis Singapore and Asian emerging markets, said.
Given these circumstances, workplaces of today must shift their priorities from hiring talented people to keeping talented people talented and happy, as Co-founder and CEO of Cognifyx, Navdeep Vij Singh, pointed out. This can be achieved by designing more supportive work policies or driving workplace culture changes that educate the workforce about migraine. “By ensuring patients and physicians are aware of the options available to support them in managing the condition, we can also make a significant step in alleviating the impact of the affected people,” said Celine Landie.
Dr Finkelstein hopes that quantifying the economic burden of migraine will accelerate progress in this field of research, catalyse conversations and support measures towards addressing problems like these that impacts the society as a whole.
This article was contributed by Michelle Tan Min Shuen, an editorial intern at World Scientific Publishing Co. and a contributing writer for Asia-Pacific Biotech News. She is from Nanyang Girls' High School, has a keen interest in chemistry and the life sciences, and pursues taekwondo in her free time.