Silverman Stuart, Dukes Ellen M, Johnston Stephen S, Brandenburg Nancy A, Sadosky Alesia, Huse Dan M
University of California, Los Angeles, CA, USA.
Curr Med Res Opin. 2009 Apr;25(4):829-40. doi: 10.1185/03007990902728456.
To quantify and compare direct costs, utilization, and the rate of comorbidities in a sample of patients with fibromyalgia (FM), a poorly understood illness associated with chronic widespread pain that is commonly treated by rheumatologists, to patients with rheumatoid arthritis (RA), a well studied rheumatologic illness associated with inflammatory joint pain. Patients with both illnesses were isolated and reported as a third group. A secondary analysis of work loss was performed for an employed subset of these patients.
Retrospective cohort analysis of Thomson Reuters MarketScan administrative healthcare claims and employer-collected absence and disability data for adult patients with a diagnosis of FM (ICD-9-CM 729.1) and/or RA (ICD-9-CM 714.0x,-714.3x) on at least one inpatient or two outpatient claims during 2001-2004.
The 12-month healthcare utilization, expenditures, and rates of comorbidities were quantified for all study-eligible patients; absence and short-term disability days and costs were quantified for an employed subset.
The sample included 14034 FM, 7965 RA, and 331 FM+RA patients. Patients with FM had a higher prevalence of several comorbidities and greater emergency department (ED) utilization than those with RA. Mean annual expenditures for FM patients were $10911 (SD=$16075). RA patient annual expenditures were similar to FM: $10716 (SD= $16860). Annual expenditures were almost double in patients with FM+RA ($19395, SD= $25440). A greater proportion of patients with FM had any short-term disability days than those with RA (20 vs. 15%); and a greater proportion of patients with RA had any absence days (65 vs. 80%). Mean costs for absence from work and short-term disability in the FM and RA groups were substantial and similar. The FM+RA group was of insufficient sample size to report on work loss.
The availability of newer and more expensive FDA-approved medications since 2004 is not reflected in our findings. This analysis was restricted to commercially insured patients and therefore may not be generalizable to the entire U.S. population.
The burden of illness in FM is substantial and comparable to RA. Patients with FM incurred direct costs approximately equal to RA patients. Patients with FM had more ED, physician, and physical therapy visits than RA patients. Patients in both groups had several comorbidities. Patients with FM+RA incurred direct costs almost double those of the patients with either diagnosis alone. FM and RA patients incurred similar overall absence and short-term disability costs.
对纤维肌痛（FM）患者样本的直接成本、医疗服务利用情况及共病发生率进行量化和比较。纤维肌痛是一种了解较少的疾病，伴有慢性广泛性疼痛，通常由风湿病学家进行治疗；将其与类风湿关节炎（RA）患者进行比较，类风湿关节炎是一种经过充分研究的风湿性疾病，伴有炎症性关节疼痛。患有这两种疾病的患者单独分离出来并作为第三组进行报告。对这些患者中有工作的子集进行了工作损失的二次分析。
对汤姆森路透市场扫描管理医疗保健索赔以及雇主收集的缺勤和残疾数据进行回顾性队列分析，这些数据来自2001 - 2004年期间至少有一次住院或两次门诊索赔记录、诊断为FM（国际疾病分类第九版临床修正本[ICD - 9 - CM] 729.1）和/或RA（ICD - 9 - CM 714.0x，-714.3x）的成年患者。
对所有符合研究条件的患者的12个月医疗服务利用情况、支出及共病发生率进行量化；对有工作的子集的缺勤天数、短期残疾天数及成本进行量化。
样本包括14034例FM患者、7965例RA患者和331例FM + RA患者。FM患者的几种共病患病率更高，急诊科（ED）利用率也高于RA患者。FM患者的年均支出为10911美元（标准差 = 16075美元）。RA患者的年均支出与FM患者相似：10716美元（标准差 = 16860美元）。FM + RA患者的年均支出几乎是前两者的两倍（19395美元，标准差 = 25440美元）。FM患者中出现任何短期残疾天数的比例高于RA患者（20%对15%）；而RA患者中出现任何缺勤天数的比例更高（65%对80%）。FM组和RA组因缺勤和短期残疾产生的平均成本很高且相近。FM + RA组样本量不足，无法报告工作损失情况。
2004年以来更新的、更昂贵的美国食品药品监督管理局（FDA）批准药物的可用性未在我们的研究结果中体现。该分析仅限于商业保险患者，因此可能无法推广至整个美国人群。
FM的疾病负担很重，与RA相当。FM患者产生的直接成本与RA患者大致相当。FM患者的急诊科就诊、看医生及接受物理治疗的次数比RA患者多。两组患者都有几种共病。FM + RA患者产生的直接成本几乎是仅患其中一种疾病患者的两倍。FM和RA患者产生的总体缺勤和短期残疾成本相近。
