title: Characteristics, treatment, and health care expenditures of Medicare supplemental-insured patients with painful diabetic peripheral neuropathy, post-herpetic neuralgia, or fibromyalgia.
abstract: OBJECTIVE
  To describe the characteristics, treatment, and health care expenditures of Medicare Supplemental-insured patients with painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), or fibromyalgia.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  United States clinical practice, as reflected within a database comprising administrative claims from 2.3 million older adults participating in Medicare supplemental insurance programs.
  
  
  METHODS
  Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009, and had ≥1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or fibromyalgia, followed within 60 days by a medication or pain intervention procedure used in treating pDPN, PHN, or fibromyalgia during 2008-2009.
  
  
  METHODS
  Utilization of, and expenditures on, pain-related and all-cause pharmacotherapy and medical interventions in 2009.
  
  
  RESULTS
  The study included 25,716 patients with pDPN (mean age 75.2 years, 51.2% female), 4,712 patients with PHN (mean age 77.7 years, 63.9% female), and 25,246 patients with fibromyalgia (mean age 74.4 years, 73.0% female). Patients typically had numerous comorbidities, and many were treated with polypharmacy. Mean annual expenditures on total pain-related health care and total all-cause health care, respectively, (in 2010 USD) were: $1,632, $24,740 for pDPN; $1,403, $16,579 for PHN; and $1,635, $18,320 for fibromyalgia. In age-stratified analyses, pain-related health care expenditures decreased as age increased.
  
  
  CONCLUSIONS
  The numerous comorbidities, polypharmacy, and magnitude of expenditures in this sample of Medicare supplemental-insured patients with pDPN, PHN, or fibromyalgia underscore the complexity and importance of appropriate management of these chronic pain patients.
authors.affiliation: Truven Health Analytics, Bethesda, MD.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Johnston
authors.forename: Margarita
authors.initials: M
authors.lastname: Udall
authors.forename: Jose
authors.initials: J
authors.lastname: Alvir
authors.forename: Donna
authors.initials: D
authors.lastname: McMorrow
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.forename: Daniel
authors.initials: D
authors.lastname: Mullins
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003929:Diabetic Neuropathies / Q000191:economics / Q000628:therapy*; D005260:Female; D005356:Fibromyalgia / Q000191:economics / Q000628:therapy*; D005102:Health Expenditures; D006801:Humans; D008297:Male; D016345:Medicare Part B / Q000191:economics*; D051474:Neuralgia, Postherpetic / Q000191:economics / Q000628:therapy*; D059408:Pain Management / Q000191:economics* / Q000706:statistics & numerical data; D019338:Polypharmacy; D012189:Retrospective Studies; D014481:United States
keywords: Fibromyalgia; Health Care Expenditures; Health Care Utilization; Medicare; Painful Diabetic Peripheral Neuropathy; Post-Herpetic Neuralgia