title: Real-world evaluation of health-care resource utilization and costs in employees with fibromyalgia treated with pregabalin or duloxetine.
abstract: OBJECTIVE
  To evaluate changes in health-care resource use and costs after initiating pregabalin or duloxetine in employees with fibromyalgia (FM).
  
  
  METHODS
  Employees (18 to 64 years old) with at least one claim for an FM-attributable medication within 60 days following an FM diagnosis were identified using the Thomson Reuters MarketScan(®) Commercial Database (2006 to 2008). Patients newly initiated on pregabalin were propensity score matched to patients newly initiated on duloxetine. These treatment cohorts were evaluated for changes between the 6-month pre- and post-initiation periods in health-care utilization including prescriptions, imputed medically related work loss and expenditures. Pre- to post-initiation changes were compared between pregabalin and duloxetine using a difference-in-difference approach based on univariate statistics and multivariable models.
  
  
  RESULTS
  A total of 731 employees with FM initiated on pregabalin (89.9% female, mean age 47.1±9.7 years) were matched with 731 employees initiated on duloxetine (89.5% female, mean age 47.1±9.8 years); other demographic and clinical characteristics were also comparable between cohorts. The adjusted marginal effects were not statistically significant for pre- to post-changes in opioid utilization (P=0.856), number of FM-attributable (P=0.151) or FM-related medications (P=0.462), and all-cause (P=0.323) or FM-attributable (P=0.991) expenditures. Pregabalin was associated with a significantly lower probability of any medically related work loss of 3.2 percentage points (P=0.030) compared with duloxetine, but changes in indirect costs were not significantly different (P=0.600).
  
  
  CONCLUSIONS
  The changes in health resource utilization and costs after initiation of pregabalin were not significantly different than the changes observed after initiation of duloxetine. These results not only demonstrate an overall similarity of resource utilization, but also suggest cost neutrality between pregabalin and duloxetine.
authors.affiliation: U.S. Health Economics and Outcomes Research, Global Market Access, Primary Care Business Unit, Pfizer, Inc., New York, New York 10017, USA. james.harnett@phizer.com
authors.forename: James
authors.initials: J
authors.lastname: Harnett
authors.forename: Jay
authors.initials: J
authors.lastname: Margolis
authors.forename: Zhun
authors.initials: Z
authors.lastname: Cao
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sanchez
authors.forename: Jack
authors.initials: J
authors.lastname: Mardekian
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use; D003863:Depression / Q000209:etiology; D000068736:Duloxetine Hydrochloride; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069583:Pregabalin; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use*; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000068736:Duloxetine Hydrochloride