Avalon Health Solutions, Inc., Philadelphia, PA 19102, USA.
J Med Econ. 2012;15(1):32-44. doi: 10.3111/13696998.2011.629263. Epub 2011 Oct 20.
To examine treatment patterns and costs among patients with fibromyalgia prescribed pregabalin or tricyclic antidepressants (TCAs).
Using the LifeLink™ Health Plan Claims Database, patients with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) newly prescribed (index date) TCAs (n = 898) were identified and propensity score-matched (PSM) with patients newly prescribed pregabalin (n = 898). Pain-related pharmacotherapy, comorbidities, and healthcare resource use/costs were examined during the 12 months, pre-index, and follow-up periods.
Both patient groups reported multiple comorbidities and received pain medications in the pre-index and follow-up periods. Among patients prescribed pregabalin, use of non-selective non-steroidal anti-inflammatory drugs (43.3% vs 39.8%), other anticonvulsants (28.6% vs 23.3%), and tetracyclic/miscellaneous antidepressants (28.5% vs 25.8%) significantly decreased, and cyclooxygenase 2 (COX-2) inhibitors (7.7% vs 10.4%), TCAs (4.8% vs 7.9%), and topical agents (10.8% vs 15.1%) increased in the follow-up period (p < 0.05). Among patients prescribed TCAs, there were significant decreases in muscle relaxants (42.0% vs 38.4%) and sedative hypnotics (27.4% vs 23.9%), and increases in COX-2 inhibitors (5.8% vs 7.9%) and anticonvulsants (25.1% vs 33.7%; p < 0.05). There were increases (p < 0.0001) in pharmacy costs in both cohorts and total healthcare costs in the pregabalin cohort from pre-index to follow-up. Median total costs were higher (p < 0.05) in the pregabalin group vs TCAs in the pre-index ($9935 vs $8771) and follow-up ($10,689 vs $8379) periods.
Despite attempts to address bias through PSM, the higher pre-index costs in the pregabalin cohort suggest a channeling of patients with more severe fibromyalgia to pregabalin.
Patients with fibromyalgia prescribed pregabalin or TCAs had multiple comorbidities and a sizeable pain medication burden, which increased in the follow-up period for both cohorts. Only 5% of pregabalin initiators had been treated with concomitant TCAs at baseline, suggesting that TCAs were inappropriate for these patients owing to their contraindications.
研究新处方普瑞巴林或三环类抗抑郁药（TCAs）治疗纤维肌痛患者的治疗模式和费用。
使用 LifeLinkTM 健康计划理赔数据库，确定新处方 TCAs（索引日期）的纤维肌痛患者（国际疾病分类，第 9 版，临床修正码 729.1X）（n=898），并与新处方普瑞巴林的患者进行倾向评分匹配（PSM）（n=898）。在 12 个月、索引前和随访期间，检查与疼痛相关的药物治疗、合并症和医疗资源使用/费用。
两组患者均报告有多种合并症，并在索引前和随访期间使用了疼痛药物。在接受普瑞巴林治疗的患者中，非选择性非甾体抗炎药（43.3%对 39.8%）、其他抗惊厥药（28.6%对 23.3%）和四环/杂环抗抑郁药（28.5%对 25.8%）的使用率显著下降，环氧化酶 2（COX-2）抑制剂（7.7%对 10.4%）、TCAs（4.8%对 7.9%）和局部制剂（10.8%对 15.1%）在随访期间增加（p<0.05）。在接受 TCAs 治疗的患者中，肌肉松弛剂（42.0%对 38.4%）和镇静催眠药（27.4%对 23.9%）的使用率显著下降，COX-2 抑制剂（5.8%对 7.9%）和抗惊厥药（25.1%对 33.7%）的使用率增加（p<0.05）。两组患者的药房费用均增加（p<0.0001），普瑞巴林组的总医疗费用从索引前到随访期间也增加。在索引前（$9935 对 $8771）和随访期间（$10689 对 $8379），普瑞巴林组的总费用中位数均高于 TCA 组（p<0.05）。
尽管通过 PSM 试图解决偏倚问题，但普瑞巴林组在索引前较高的费用表明，病情更严重的纤维肌痛患者更倾向于使用普瑞巴林。
新处方普瑞巴林或 TCAs 的纤维肌痛患者有多种合并症，疼痛药物负担较大，两组患者在随访期间均有所增加。只有 5%的普瑞巴林新使用者在基线时同时接受 TCAs 治疗，这表明 TCAs 由于其禁忌症不适合这些患者。
