Financial and clinical characteristics of fibromyalgia: a case-control comparison.
OBJECTIVE
To compare healthcare utilization and costs between subjects with and without fibromyalgia (FM) using claims data from a large health benefits company in the United States.


METHODS
Retrospective cohort.


METHODS
We analyzed 24 months of medical and pharmacy claims data comparing healthcare utilization and costs among Humana members diagnosed with FM to a propensity score matched control group without a diagnosis for FM. FM cases were identified as members aged 18 years and older, with at least 2 medical claims for International Classification of Diseases, Ninth Revision, Clinical Modification codes 729.0 and/or 729.1. The first medical claim for FM was utilized as the index date.


RESULTS
A total of 9988 FM cases and 9988 controls were included in the analysis. Compared with controls, the use of pain-related medications by FM cases was approximately 2 times higher with opioids being used most commonly. FM cases utilized a mean (SD) of 22.5 (23.9) and 31.1 (26.6) outpatient services per year in the prediagnosis and postdiagnosis periods, respectively, compared with 14.8 (20.5) and 16.3 (24.5) among controls (P <.01). Office visits, tests, and procedures represented the majority of utilization. During the postdiagnosis period, the mean per-patient per-month costs for outpatient services among FM cases was $377 ($760) and $217 ($740.87) among controls (P <.01).


CONCLUSIONS
FM cases had significantly higher utilization and costs compared with controls. Office visits, tests and procedures, and the use of pain-related medications accounted for the largest absolute differences between the 2 groups.
Palacio
Ana
A
Department of Internal Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA. apalacio2@med.miami.edu
Uribe
Claudia L
CL
Li
Hua
H
Hanna
John
J
Deminski
Michael
M
Alvir
Jose
J
Chandran
Arthi
A
Sanchez
Robert
R
D000700:Analgesics / Q000191:economics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use; D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D004363:Drug Utilization; D005356:Fibromyalgia / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D012189:Retrospective Studies
D000700:Analgesics; D000701:Analgesics, Opioid