A prospective, longitudinal, multicenter study of service utilization & costs in fibromyalgia (FM)

OBJECTIVE: To study, for the first time, service utilization

and costs in fibromyalgia, a prevalent syndrome associated

with high levels of pain, functional disability, and emotional

distress.

METHODS: Five hundred thirty-eight fibromyalgia

patients from 6 rheumatology centers were enrolled in a 7-year

prospective study of fibromyalgia outcome. Patients were

assessed every 6 months with validated, mailed questionnaires

which included questions regarding fibromyalgia symptoms and

severity, utilization of services, and work disability.

RESULTS: Fibromyalgia patients averaged almost 10 outpatient

medical visits per year, and when nontraditional treatments

were considered, this number increased to approximately 1

visit per month. Patients were hospitalized at a rate of 1

hospitalization every 3 years. In each 6-month study period,

patients used a mean of 2.7 fibromyalgia-related drugs. Costs

increased over the course of the study. The mean yearly

per-patient cost in 1996 dollars was $2,274. However, results

were skewed by high utilizers, and many patients used few

services and had limited costs. Total costs and utilization

were independently associated with the number of self-reported

comorbid or associated conditions, functional disability, and

global disease severity. Compared with patients with other

rheumatic disorders, those with fibromyalgia were more likely

to have lifetime surgical interventions, including back or

neck surgery, appendectomy, carpal tunnel surgery, gynecologic

surgery, abdominal surgery, and tonsillectomy, and were more

likely than other rheumatic disease patients to report

comorbid or associated conditions. Almost 50% of

hospitalizations occurring during the study were related to

fibromyalgia-associated symptoms.

CONCLUSION: The average

yearly cost for service utilization among fibromyalgia

patients is $2,274. Fibromyalgia patients have high lifetime

and current rates of utilization of all types of medical

services. They report more symptoms and comorbid or associated

conditions than patients with other rheumatic conditions, and

symptom reporting is linked to service utilization and, to a

lesser extent, functional disability and global disease

severity.

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