Should a Health Plan Pay for a Lifestyle Coach?

How The Rhythm of Life Affects Your Health

Today, the prestigious New England Journal of Medicine published two big pharma sponsored research studies for the treatment of migraine.

Migraine is a common brain disease and one of the top reasons of disability. Patients with migraine have bad headaches, nausea, aura, sensitivity to sound and light.

They studied monthly injections of monoclonal antibodies to CGRP- Calcitonin Gene Related Peptide for the prevention of migraine.

Erenumab was used for Episodic migraine, which is the more common type- over 90% of migraine patients, and these patients have less than 15 days of headache per month. Fremanezumab was used for people with chronic migraine. These people have more than 15 days of headache a month for at least 3 months.

A good clinical response to migraine therapy was defined as at least a 50% reduction in mean migraine days per month.

The clinical response rate in the erenumab group was 50.0%, as compared with 26.6% in the placebo group.

The clinical response rate in the fremanezumab group was 41%, as compared with 18% in the placebo group.

This is exciting news, but it made me think how the clinical use guideline and Prior Authorization process would work.

These new drugs are going to be specialty drugs- Injectable, and Expensive !

Simple lifestyle rhythm habits can make a big impact on our health- even Migraine.

Keeping a Regular Lifestyle Behavior [RLB] schedule of Sleep, Food, and Exercise is the key to preventing migraine.

Maintaining regular sleep hours with consistent sleep–wake
time both in weekdays and weekends

Maintaining regular daily mealtime and adequate hydration status, and

Maintaining daily aerobic exercise of any form for a minimum
20 min duration that raises heart rate.

Those patients maintaining all three domains were designated
as RLB+; those patients not maintaining all three
domains were designated as RLB-.

Absolute Risk Reduction of 47 % clearly means that people with Regular Lifestyle Behavior were protected from developing chronic migraine.

The benefit of RLB was observed at least at every 2nd patient treated- the Number Needed to Treat NNT of 2.

A lifestyle coach that can help people with migraine establish and maintain Regular Lifestyle Behavior seems like a good investment.

Why should we not try a natural, lower cost, preventive step to help these patients first?

If all else fails, then we go to the new injections at a very high cost.


Translate »