Vervoort Vera M, Vriezekolk Johanna E, Olde Hartman Tim C, Cats Hans A, van Helmond Toon, van der Laan Willemijn H, Geenen Rinie, van den Ende Cornelia H
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Clin Exp Rheumatol. 2016 Mar-Apr;34(2 Suppl 96):S74-82. Epub 2016 Feb 8.
The disease impact and economic burden of fibromyalgia (FM) are high for patients and society at large. Knowing potential determinants of economic costs may help in reducing this burden. Cognitive appraisals (perceptions) of the illness could affect costs. The present study estimated costs of illness in FM and examined the association between these costs and illness perceptions.
Questionnaire data of FM severity (FIQ), illness perceptions (IPQ-R-FM), productivity losses (SF-HLQ) and health care use were collected in a cohort of patients with FM. Costs were calculated and dichotomised (median split). Univariate and hierarchic logistic regression models examined the unique association of each illness perception with 1) health care costs and 2) costs of productivity losses. Covariates were FM severity, comorbidity and other illness perceptions.
280 patients participated: 95% female, mean age 42 (SD=12) years. Annualised costs of FM per patient were €2944 for health care, and €5731 for productivity losses. In multivariate analyses, a higher disease impact (FIQ) and two of seven illness perceptions (IPQ-R-FM) were associated with high health care costs: 1) high scores on 'cyclical timeline' reflecting a fluctuating, unpredictable course and 2) low scores on 'emotional representations', thus not perceiving a connection between fibromyalgia and emotions. None of the variables was associated with productivity losses.
Our study indicates that perceiving a fluctuating course and low emotional representation, which perhaps reflects somatic fixation, are associated with health care costs in FM. Future studies should examine whether targeting these illness perceptions results in reduction of costs.
纤维肌痛（FM）对患者及整个社会造成的疾病影响和经济负担都很高。了解经济成本的潜在决定因素可能有助于减轻这一负担。对疾病的认知评估（看法）可能会影响成本。本研究估算了FM的疾病成本，并考察了这些成本与疾病认知之间的关联。
收集了一组FM患者的FM严重程度（FIQ）、疾病认知（IPQ-R-FM）、生产力损失（SF-HLQ）和医疗保健使用情况的问卷数据。计算成本并进行二分法（中位数分割）。单变量和分层逻辑回归模型考察了每种疾病认知与1）医疗保健成本和2）生产力损失成本之间的独特关联。协变量包括FM严重程度、合并症和其他疾病认知。
280名患者参与研究：95%为女性，平均年龄42（标准差=12）岁。每位患者FM的年度化成本为：医疗保健2944欧元，生产力损失5731欧元。在多变量分析中，较高的疾病影响（FIQ）和七种疾病认知中的两种（IPQ-R-FM）与高医疗保健成本相关：1）“周期性时间线”得分高，反映病情波动、不可预测；2）“情感表征”得分低，即未察觉到纤维肌痛与情绪之间的联系。没有变量与生产力损失相关。
我们的研究表明，认为病情波动且情感表征低（这可能反映了躯体固着）与FM的医疗保健成本相关。未来的研究应考察针对这些疾病认知是否能降低成本。
