Jacob T Painter1, Leslie J Crofford1, J S Butler1, Jeffery Talbert1. 1. Division of Pharmaceutical Evaluation & Policy, College of Pharmacy, University of Arkansas for Medical Sciences(JTP), Little Rock, AR; Department of Internal Medicine, Division of Rheumatology & Women's Health, College of Medicine, Vanderbilt University (LJC), Nashville, TN; Department of Pharmacy Practice, College of Pharmacy (JT), Martin School of Public Policy & Administration, University of Kentucky (JSB), Lexington, KY.
Abstract
BACKGROUND: Fibromyalgia (FM) is an idiopathic, functional syndrome characterized by chronic, widespread pain and diffuse tenderness. This disorder affects more than 6 million patients in the United States and is associated with significant clinical and economic burdens. OBJECTIVES: The objectives of this study were to: 1) estimate the costs associated with a FM diagnosis; and 2) estimate the impact of chronic opioid use on the costs of FM patients. RESEARCH DESIGN: Case-control study. METHODS: Subjects were identified in a large nationally representative database of commercially insured patients. Propensity score-matched analyses included 445,912 FM-control pairs in the first analysis, while the second analysis included 48,333 chronic opioid users with the FM-control pairs. Primary outcomes of interest were the medical and prescription costs compared between matched pairs, based on propensity for being a case as evidenced by coefficients obtained from a first-stage logistic regression. Patient characteristics considered include: state of residence, diagnosing provider type, comorbid conditions, and concurrent medication use. RESULTS: When controlling for propensity to receive a FM diagnosis, the actual diagnosis has a small effect on medical (-$83.54 [95% CI, -152.55 to -16.53]) and prescription ($120.31 [95% CI, 109.98-130.62]) costs. However, the effect of chronic opioid use in FM patients on medical ($9094.05 [95% CI, 8924.79-9263.31]) and prescription ($3391.81 [95% CI, 3368.84-3414.79]) costs is much more substantial. CONCLUSIONS: While the differences seen in FM patients and controls are marginal, those attributed to chronic opioid use in these patients are significantly higher. Chronic opioid therapy to treat FM is a practice based not on evidence available to practitioners, but on other variables.
BACKGROUND:Fibromyalgia (FM) is an idiopathic, functional syndrome characterized by chronic, widespread pain and diffuse tenderness. This disorder affects more than 6 million patients in the United States and is associated with significant clinical and economic burdens. OBJECTIVES: The objectives of this study were to: 1) estimate the costs associated with a FM diagnosis; and 2) estimate the impact of chronic opioid use on the costs of FM patients. RESEARCH DESIGN: Case-control study. METHODS: Subjects were identified in a large nationally representative database of commercially insured patients. Propensity score-matched analyses included 445,912 FM-control pairs in the first analysis, while the second analysis included 48,333 chronic opioid users with the FM-control pairs. Primary outcomes of interest were the medical and prescription costs compared between matched pairs, based on propensity for being a case as evidenced by coefficients obtained from a first-stage logistic regression. Patient characteristics considered include: state of residence, diagnosing provider type, comorbid conditions, and concurrent medication use. RESULTS: When controlling for propensity to receive a FM diagnosis, the actual diagnosis has a small effect on medical (-$83.54 [95% CI, -152.55 to -16.53]) and prescription ($120.31 [95% CI, 109.98-130.62]) costs. However, the effect of chronic opioid use in FM patients on medical ($9094.05 [95% CI, 8924.79-9263.31]) and prescription ($3391.81 [95% CI, 3368.84-3414.79]) costs is much more substantial. CONCLUSIONS: While the differences seen in FM patients and controls are marginal, those attributed to chronic opioid use in these patients are significantly higher. Chronic opioid therapy to treat FM is a practice based not on evidence available to practitioners, but on other variables.
Authors: A Boonen; R van den Heuvel; A van Tubergen; M Goossens; J L Severens; D van der Heijde; S van der Linden Journal: Ann Rheum Dis Date: 2004-07-22 Impact factor: 19.103
Authors: S F Carville; L Arendt-Nielsen; S Arendt-Nielsen; H Bliddal; F Blotman; J C Branco; D Buskila; J A P Da Silva; B Danneskiold-Samsøe; F Dincer; C Henriksson; K G Henriksson; E Kosek; K Longley; G M McCarthy; S Perrot; M Puszczewicz; P Sarzi-Puttini; A Silman; M Späth; E H Choy Journal: Ann Rheum Dis Date: 2007-07-20 Impact factor: 19.103