Pfizer, Inc., New York, NY, USA.
Curr Med Res Opin. 2011 Mar;27(3):663-71. doi: 10.1185/03007995.2010.550605. Epub 2011 Jan 18.
To evaluate health care resource utilization and costs 1 year before and 3 years after a fibromyalgia (FM) diagnosis.
This retrospective cohort analysis used claims from Humana to identify newly diagnosed FM patients ≥18 years of age based on ≥2 medical claims for ICD-9 CM code 729.1 and 729.0 between June 1, 2002 and March 1, 2005. Prevalence of comorbidities, as well as utilization and costs of pharmacotherapy and health care services were examined for 12 months preceding (pre-diagnosis) and 36 months following (post-diagnosis) the date of first FM diagnosis. These periods were subdivided into 6-month blocks to better observe patterns of change.
We identified 2613 FM patients who had a mean age at diagnosis of 58.5 ± 15.3 years and a mean Charlson Comorbidity Index of 0.48 ± 1.05. Of those, 73% were female. The use and costs of pain-related medications rose from pre-diagnosis and remained stable after the 6-month post-diagnosis period, while the use of non-pain-related medications steadily rose from pre-diagnosis to 3 years post-diagnosis. This increase was concomitant with an increase in the presence of conditions that may account for higher resource utilization. The use of recommended FM therapies (i.e., antidepressants and anticonvulsants) increased post-diagnosis but remained less common than other pain-related therapies. Total resource utilization and costs increased during the period up to 6 months after diagnosis. This increase was followed by a decline (7-12 months post-diagnosis), and plateau, with an increase during the final 6 months of the study period. Total mean per patient costs were $3481 for the 6-month post-diagnosis period, and $3588 for the final 6 months. Limitations include potential errors in coding and recording, and an inability of claims analyses to determine causality between resource utilization and the specific diagnosis of interest.
An FM diagnosis was associated with increased utilization and pain-related medication cost up to the first 6 months post-diagnosis followed by stabilization over 3 years post-diagnosis. Less use of recommended therapies relative to other therapies suggests that further dissemination of treatment guidelines is needed. An increase in non-pain medications over the observation period accounted for the majority of pharmacy costs. These pharmacy costs may be related to an increasing prevalence of comorbid conditions.
评估纤维肌痛（FM）诊断前 1 年和诊断后 3 年的医疗资源利用和成本。
本回顾性队列分析使用 Humana 的索赔数据，根据 2002 年 6 月 1 日至 2005 年 3 月 1 日 ICD-9-CM 代码 729.1 和 729.0 至少有 2 次医疗索赔，确定≥18 岁的新诊断 FM 患者。在 FM 诊断日期前 12 个月（诊断前）和诊断后 36 个月（诊断后）检查共病的流行情况以及药物治疗和医疗服务的利用和成本。这些时期被细分为 6 个月的块，以更好地观察变化模式。
我们确定了 2613 名 FM 患者，他们的平均诊断年龄为 58.5±15.3 岁，平均 Charlson 合并症指数为 0.48±1.05。其中，73%为女性。疼痛相关药物的使用和成本从诊断前开始上升，并在诊断后 6 个月的治疗期保持稳定，而非疼痛相关药物的使用则从诊断前稳步上升至诊断后 3 年。这种增加伴随着可能导致更高资源利用的疾病的增加。推荐的 FM 治疗方法（即抗抑郁药和抗惊厥药）的使用在诊断后增加，但仍低于其他疼痛相关治疗方法。在诊断后 6 个月内，总资源利用和成本增加。这一增长之后是下降（诊断后 7-12 个月）和稳定，在研究期间的最后 6 个月增加。每位患者的平均总成本为诊断后 6 个月的 3481 美元，最后 6 个月的 3588 美元。局限性包括编码和记录中的潜在错误，以及索赔分析无法确定资源利用与特定诊断之间的因果关系。
FM 诊断与诊断后 6 个月内的利用和疼痛相关药物成本增加有关，随后在诊断后 3 年内稳定。与其他疗法相比，建议疗法的使用较少表明需要进一步传播治疗指南。在观察期间，非疼痛药物的使用增加占大部分药房成本。这些药房成本可能与共病发生率的增加有关。
