title: Impact of fibromyalgia severity on health economic costs: results from a European cross-sectional study.
abstract: BACKGROUND
  Fibromyalgia (FM) is a chronic disorder characterized by persistent and widespread pain, often accompanied with fatigue, sleep disturbance and other symptoms. FM affects a population mostly of a productive age and is thus associated with significant lost productivity and disability, in addition to healthcare costs for medications and physician office visits. While other studies have examined FM costs in Europe, few, if any, have examined cost by FM severity level.
  
  
  OBJECTIVE
  The objective of this study was to examine health resource utilization (HRU) and costs associated with FM in routine clinical practice in France and Germany across disease severity levels.
  
  
  METHODS
  A total of 299 patients with FM, previously diagnosed by a rheumatologist, were recruited from physician offices in France and Germany during routine visits. Subjects completed questions about their pain, health-related quality of life, treatment satisfaction, productivity and FM-related out-of-pocket expenses; site staff recorded clinical, treatment and HRU information for the previous 3 months based on a review of medical records. FM severity was defined using subjects' Fibromyalgia Impact Questionnaire (FIQ) total scores. Annual costs from a societal perspective were calculated in €, year 2008 values, and included direct costs (e.g. physician office visits, medications, out-of-pocket expenses) and indirect costs (e.g. missed days of work and lost productivity). The mean annual costs were calculated based on 3-month data.
  
  
  RESULTS
  Subjects were reported to have a mean (SD) of 2.9 (1.9) physician office visits in France and 4.9 (3.2) visits in Germany over the past 3 months, corresponding to an average of 11.6 and 19.6 visits a year, respectively. A total of 91% of subjects were receiving prescription medication for their FM. French subjects reported a lower use of anti-inflammatories (39% of subjects) and a higher use of other analgesics (59% of subjects) than German subjects (67% and 34%, respectively). Subjects in full- or part-time employment reported missing a mean (SD) of 2.7 (6.0) days of work due to FM in France and 2.1 (3.8) days in Germany over the last 4 weeks (corresponding to 32.4 and 25.2 days of work missed due to FM per year in France and Germany, respectively). In France, total costs were €7900 (direct €910, indirect €6990). In Germany, total costs were €7256 (direct €1765, indirect €5491). A trend of higher total costs was seen as FM severity increased; however, the results were significant (p = 0.003) only for Germany.
  
  
  CONCLUSIONS
  FM imposes a significant economic burden on society. Consistent with other studies, FM subjects were found to have substantial costs, over 75% of which were driven by indirect costs from lost productivity. These costs increased as FM severity increased, resulting in a more than 200% difference in cost between mild and severe FM. Overall FM costs were similar between France and Germany; although lost productivity accounted for a higher proportion of costs in France.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University Hospital Munich, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Winkelmann
authors.forename: Serge
authors.initials: S
authors.lastname: Perrot
authors.forename: Caroline
authors.initials: C
authors.lastname: Schaefer
authors.forename: Kellie
authors.initials: K
authors.lastname: Ryan
authors.forename: Arthi
authors.initials: A
authors.lastname: Chandran
authors.forename: Alesia
authors.initials: A
authors.lastname: Sadosky
authors.forename: Gergana
authors.initials: G
authors.lastname: Zlateva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004526:Efficiency; D005260:Female; D005356:Fibromyalgia / Q000191:economics*; D005602:France; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult