Comparison of health care use and costs in newly diagnosed and established patients with fibromyalgia.
In 2004, the American Pain Society (APS) issued evidence-based fibromyalgia treatment recommendations. The objective of this claims database analysis is to describe prescription and medical use in patients with newly diagnosed and established fibromyalgia. Privately insured patients with 2+ myalgia/myositis claims (1999 to 2005) were categorized as newly diagnosed or established; this dichotomy involves comparisons between prediagnosis (S1) and postdiagnosis (S2) stages in the newly diagnosed and between newly diagnosed (S2) and established patients (S3). Use of APS guideline medications increased across stages: selective serotonin reuptake inhibitors (SSRIs) (S1, S2, S3: 20.6%, 22.9%, 25.3%), serotonin norepinephrine reuptake inhibitors (SNRIs) (4.5%, 6.4%, 8.9%), pregabalin/gabapentin (5.4%, 7.4%, 8.8%), benzodiazepines (19.0%, 21.1%, 24.2%), non-benzodiazepine sedatives (9.1%, 11.5%, 13.7%) (all P < .0001), and opioids (39.5%, 43.3%, 43.9%; S1 vs S2, P < .0001; S2 vs S3, P = .2835). Use of multiple therapeutic classes also increased across stages: 3+ classes (7.1%, 9.6%, 11.8%) (all P < .0001). Office visits to providers increased, on average, after diagnosis: primary care (70.9%, 78.3%, 76.3%; all P < .0001), chiropractors (28.8%, 51.1%, 53.3%; all P < .0001), rheumatologists (4.2%, 9.9%, 10.5%; S1 vs S2, P < .0001; S2 vs S3, P = .0595), mental health (6.4%, 7.3%, 8.3%; S1 vs S2, P < .0001, S2 vs S3, P = .0003). Average health care costs rose after diagnosis in the newly diagnosed group (S1: $6555 vs S2: $8654, P < .0001).


CONCLUSIONS
This paper investigates prescription drug and medical care use with respect to stages of fibromyalgia diagnosis. Established fibromyalgia patients use more medical resources and have higher rates of concomitant medication use than newly diagnosed fibromyalgia patients. Findings can help educate providers regarding optimal drug treatment patterns in this population.
White
Leigh Ann
LA
Analysis Group, Inc, Boston, Massachusetts, USA.
Robinson
Rebecca L
RL
Yu
Andrew P
AP
Kaltenboeck
Anna
A
Samuels
Seth
S
Mallett
David
D
Birnbaum
Howard G
HG
D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D001569:Benzodiazepines / Q000191:economics / Q000627:therapeutic use; D002684:Chiropractic / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D017281:Cost of Illness; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D006264:Health Benefit Plans, Employee / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data* / Q000639:trends; D006295:Health Resources / Q000191:economics; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000191:economics / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics; D055553:Prescription Drugs; D012219:Rheumatology / Q000191:economics / Q000706:statistics & numerical data
D000701:Analgesics, Opioid; D000927:Anticonvulsants; D000928:Antidepressive Agents; D055553:Prescription Drugs; D001569:Benzodiazepines