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Comparison of Health Care Use and Costs in Newly Diagnosed and Established Patients with Fibromyalgia - Source: Journal of Pain, Jun 25, 2009

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By Leigh Ann White, Rebecca L Robinson, et al. • www.ProHealth.com • July 15, 2009


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 American Pain Society guideline medications increased across stages:

• Selective serotonin reuptake inhibitors (SSRIs) (prediagnosis, postdiagnosis/newly diagnosed, established patients: 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%; prediagnosis vs postdiagnosis/newly diagnosed, P < .0001; newly diagnosed vs established patients, 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%; prediagnosis vs newly diagnosed, P < .0001; newly diagnosed vs established patients, P = .0595),

• Mental health (6.4%, 7.3%, 8.3%; prediagnosis vs newly diagnosed, p<.0001, newly diagnosed vs established patients, P = .0003).

Average health care costs rose after diagnosis in the newly diagnosed group (prediagnosis: $6,555 vs newly diagnosed: $8,654, P < .0001).

Perspective:

• 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.

Source: Journal of Pain, Jun 25, 2009. White LA, Robinson RL, Yu AP, Kaltenboeck A, Samuels S, Mallett D, Birnbaum HG. Analysis Group, Inc, Boston, Massachusetts; Eli Lilly and Company, Indianapolis, Indiana; Ingenix, Inc, Rocky Hill, Connecticut, USA. [E-mail: rlrobinson@lilly.com]





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