Background:The eligible patient population for radioligand therapies (RLTs) has the potential to grow rapidly in the coming years. European healthcare systems may be ill-prepared to provide the additional treatment capacity required on top of current workload. To address this challenge, data on the size of the eligible patient pool and the potential utilisation of RLTs are needed. Methods:The maximum pool of patients theoretically eligible for RLTs over the next decade was estimated for the 27 EU member states (EU-27) using incidence data, and additionally for France, Germany, Italy, Spain (EU-4) and the UK using prevalence data. Conditions for which RLT are currently authorised, potential expansions of existing authorisations to earlier disease stages, and anticipated authorisations for products in development were analysed. Findings:Between 2025 and 2035 in the EU-27, the patient pool theoretically eligible for RLTs could increase from 11,000 to 13,000 to approximately 130,000-180,000. A scenario based on preliminary utilisation data suggests that, in the EU-4, 17,000-35,000 patients from this pool could be treated in 2030, increasing to approximately 37,000 patients by 2035. Interpretation:The expected uptake of RLTs in EU healthcare systems over the coming decade may overwhelm available treatment capacity, even in countries with well-developed nuclear medicine infrastructure. Efforts across all EU countries will be required to ensure adequate patient access to RLTs and to minimise health inequalities in cancer care. Funding:Research by WifOR was funded by Novartis Pharma AG. JRC research was covered by the European Commission's Research Framework Programmes budget.

Radiopharmaceutical therapy (RPT) is established as an innovative, effective, and well-tolerated treatment platform approved for well-differentiated neuroendocrine tumors and advanced prostate cancer (PC) and is being investigated in many other cancers such as breast, lung, and thyroid ([1][1]–[3

To perform a return-on-investment (ROI) analysis of a migraine tele-medicine disease management program, sponsored by a company within its wellness program for its Swiss-based employees and their family members, to foster patient empowerment to multidisciplinary approaches in the management of their migraine. All participants receive six sessions (monthly) of individualized telecoaching from a specialized nurse and through a specially developed module on the Migraine Buddy smartphone application. The program participants were evaluated in a study that assessed the impact of the program through a series of questionnaires including Migraine Disability Assessment (MIDAS) that includes validated measurement of work productivity loss through absenteeism and presenteeism caused by migraine. Program costs were estimated by considering participants who completed the program as well as those who dropped out during the course of the program. Other models inputs were MIDAS data, average annual salary of the company’s employee and working days per year. From June 2018 until November 2019, 68.5% of the participants who initially registered completed the program while 31.5% dropped out either due to comorbidities, no further interest, lost to follow-up, or left the company. Considering the data for days of work missed and work productivity reduced by half or more from the MIDAS questionnaire for study completers, it was calculated that on average participants gained 10.8 working days/year that were previously lost due to migraine, resulting in a positive ROI of 510%. In addition to ROI and work productivity gained, participants also gained on average 13.6 migraine-free days/year for their private and social life. This analysis concludes that the migraine disease management program has a high ROI informing other employers that the systematic inclusion of migraine management into corporate health management programs can be of significant benefit to the impacted individuals as well as the companies.

To assess participants' satisfaction with a Migraine Care program offered by a healthcare company as a complimentary service within its wellness program for its Swiss-based employees and their family members. The program objective was to foster patient empowerment to multidisciplinary approaches in the management of their migraine. Participants receive six sessions (monthly) of individualized telecoaching from a specialized nurse and through a specially developed module on the Migraine Buddy smartphone application. The study participants were evaluated through a series of questionnaires including Migraine Disability Assessment and Patient Activation Measure. An exit questionnaire was also administered at the end of the program (at month 6) to collect feedback from the study participants to measure satisfaction level of the services offered. Of the 141 participants enrolled into the study, 79 completed the program and provided their feedback at month 6. A total of 90% of the participants who completed the study and participated in the exit survey reported feeling improved (under 'minimally', 'much' and 'very much' categories) compared to baseline on the Patient Global Impression of Change scale. With 69% of the participants categorized as promoters (very satisfied) and 6% as detractors (not at all satisfied), the net promoter score was estimated as 63. While 43% participants reported that the program met their expectations, 33% and 22% reported that the program 'exceeded' and 'greatly exceeded' their expectations, respectively. When prompted for self-reported progress towards migraine goals and how the program helped them to better manage their migraine, 77% and 85% responded in favor of the program. The results demonstrate that an employer-sponsored migraine disease management program resulted in greater clinical improvements in employees' migraine and very high levels of satisfaction with the program informing other companies that such programs could be great enhancements of their wellness programs.

Peripheral neuropathy is a common neurologic disorder, affecting 2% to 8% of the population(1-3) in population-based studies with confirmation by neurologist examination. These prevalence numbers are remarkably stable across developed countries.(4) In 1999, 8.6% of Medicare beneficiaries had neuropathy as a primary or secondary diagnosis, and the cost of treatment was estimated at $3.5 billion (Consumer Price Index adjusted to 2013 $4.9 billion), which did not include outpatient medications.(5) Peripheral neuropathy has many causes and varies in regard to its clinical manifestations and severity. Distal symmetric polyneuropathy (DSP) is the most common pattern of peripheral neuropathy generally and the most common phenotype of neuropathy due to diabetes. Reported prevalence rates of DSP among diabetic patients range from 15% to 37% across large population-based studies, and the prevalence among those with impaired glucose tolerance has been reported to be 11%.(4,6) DSP can result in weakness, sensory loss, pain, autonomic dysfunction, gait impairment, falls, disability, and impaired quality of life.(7,8)

ObjectiveTo assess the impact of a migraine management program offered as a complimentary service by a company within its corporate well‐being program.BackgroundMigraine imposes a substantial burden on patients, families, employers, and societies. As migraine primarily affects working‐age adults, this has important implications for both employees and employers. Workplace educational and well‐being programs positively contribute to employees’ productivity, reduce costs related to absenteeism, and improve the quality of life of the employees living with migraine.MethodsThis was a non‐interventional cohort study, which followed employees and their family members over time. Participants received 1 telemedicine consultation to determine migraine diagnosis or a high probability of having migraine and 6 sessions of individualized telecoaching from a specialized nurse via a specially developed smartphone application to optimize their migraine management leveraging all appropriate medical and lifestyle options. Participants were evaluated during the program and at 3 months after completion through a series of validated questionnaires including Migraine Disability Assessment (MIDAS), Patient Activation Measure (PAM), and satisfaction with the services offered. A cost analysis was also performed to determine the economic benefit of the program considering the number of completers, dropouts, their associated program costs, MIDAS data, average salary of a Swiss employee in the pharma sector, and working days per year.ResultsOf the 141 participants enrolled in the program, 79 completed 6‐month and 42 completed 9‐month assessments. The total MIDAS scores (mean, standard deviation [SD]) significantly improved from baseline by 54% at Month 6 (15.0 [13.6] vs 6.9 [8.2]; mean [SD] reduction: 8.1 [12.9], 95% confidence interval [CI]: 5.6‐10.6; P < .0001) and by 64% at Month 9 (15.4 [14.7] vs 5.6 [6.0]; mean [SD] reduction: 9.8 [14.0], 95% CI: 6.6‐13.0; P < .0001). The PAM scores also significantly improved from baseline by 8% at Month 6 (63.8 [10.9] vs 69.6 [12.8]; mean [SD] increase: 5.8 [12.8], 95% CI: 3.2‐8.4; P = .003) and 11% at Month 9 (63.5 [10.7] vs 71.3 [12.2]; mean [SD] increase: 7.8 [11.0], 95% CI: 4.3‐11.2; P = .003). At Month 6, common coaching lessons and respective action plans focused on progressive muscle relaxation, sleep, hydration, nutrition, general disease education, and stress management. The exit survey showed that the majority of the participants who completed the program had a meaningful and sustained improvement in their overall health and reported a high level of satisfaction with the program. The cost analysis revealed that on average participants gained 10.8 (95% CI: 9.3‐12.3) working days/year that were previously lost due to migraine, resulting in a positive return on investment (ROI) of 490% (95% CI: 410%‐570%), indicating a higher magnitude of savings that could be achieved by the implementation of such program. In addition to ROI and work productivity gained, participants also gained on average 13.6 (95% CI: 9.9‐17.3) migraine‐free days/year for their private and social life.ConclusionThe employer‐sponsored disease management program provided a better understanding of migraine, promoted methods and approaches to improve management by combining medical and lifestyle options leading to significant improvements in migraine symptoms that sustained beyond the intervention, supporting prolonged effectiveness of such programs. The program also provided a high ROI to the employer, supporting that the systematic inclusion of such programs into corporate well‐being initiatives can be of significant benefit not only to the impacted individuals but to the employers as well.

Objective: To assess the impact of a migraine coaching program offered by a healthcare company as a complimentary service within its wellness program for its Swiss-based employees and their family members. Background: Migraine mainly affects people during their prime working years resulting in a substantial impact on workplace productivity. Design/Methods: Of 320 participants who registered for the program from June 2018 till mid-June 2019, 120 enrolled into a study for retrospective analysis of their data. All participants receive six sessions (monthly) of individualized telecoaching from a specialized nurse through a specially developed module on the Migraine Buddy smartphone application. The study participants were evaluated through a series of questionnaires including Migraine Disability Assessment (MIDAS), Patient Activation Measure (PAM), and the commonly used coaching lessons and implemented action plans. Results: Interim results are presented for 70 participants who completed both baseline and 3-month follow-up, of which 41 reached 6 months. The mean age (standard deviation, SD) at baseline was 39.0 (8.0) years with 67.1% females, 68.6% had a confirmed diagnosis of migraine, and 51.4% were not treated by a physician despite 72.9% having MIDAS grade ≥2. The total mean (SD) MIDAS score improved from 15.2 (14.3) at baseline to 13.7 (16.9) (p=0.342) at 3 months and to 6.5 (8.1) (p=0.001) at 6 months. The PAM scores also improved from 63.7 (11.0) at baseline to 67.5 (11.6) (p=0.012) at 3 months and to 70.8 (12.1) (p=0.0009) at 6 months. The most used coaching lessons focused on progressive muscle relaxation, sleep, general disease understanding, stress, and nutrition while top action plans addressed hydration, sleep, nutrition, daily routine and physical activity. Conclusions: The results demonstrate that employer-sponsored educational and counseling support can significantly decrease migraine-related disability and promote disease self-management among employees. Disclosure: Dr. Schaetz has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novartis Pharma AG, Switzerland. Dr. Schaetz holds stock and/or stock options in Novartis which sponsored research in which Dr. Schaetz was involved as an investigator. Dr. Rimner has nothing to disclose. Dr. Pathak has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novartis. Dr. Fang has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities as an employee of Novartis. Dr. Fang has received compensation for serving on the Board of Directors of Novartis. Dr. Fang holds stock and/or stock options in Novartis which sponsored research in which Dr. Fang was involved as an investigator. Dr. Fang holds stock and/or stock options in Novartis. Dr. Chandrasekhar has nothing to disclose. Dr. Mueller has nothing to disclose.

May 8, 2019April 9, 2019Free AccessHealthcare Expenditure in Migraine Compared to Other Leading Causes of Disability: Adequate or Not? (P4.10-009)Leonhard Schaetz, Parth Joshi, Aoife Callan, Vivek Khurana, and Jasper HuelsAuthors Info & AffiliationsApril 9, 2019 issue92 (15_supplement)https://doi.org/10.1212/WNL.92.15_supplement.P4.10-009 Letters to the Editor