Financial and clinical characteristics of fibromyalgia: a case-control comparison.

Ana M Palacio, Claudia L. Uribe, Hua Li, John Hanna, Michael Deminski, Jose Alvir, Arthi Chandran, Robert Sanchez

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVE: To compare healthcare utilization and costs between subjects with and without fibromyalgia (FM) using claims data from a large health benefits company in the United States. STUDY DESIGN: Retrospective cohort. METHODS: We analyzed 24 months of medical and pharmacy claims data comparing healthcare utilization and costs among Humana members diagnosed with FM to a propensity score matched control group without a diagnosis for FM. FM cases were identified as members aged 18 years and older, with at least 2 medical claims for International Classification of Diseases, Ninth Revision, Clinical Modification codes 729.0 and/or 729.1. The first medical claim for FM was utilized as the index date. RESULTS: A total of 9988 FM cases and 9988 controls were included in the analysis. Compared with controls, the use of pain-related medications by FM cases was approximately 2 times higher with opioids being used most commonly. FM cases utilized a mean (SD) of 22.5 (23.9) and 31.1 (26.6) outpatient services per year in the prediagnosis and postdiagnosis periods, respectively, compared with 14.8 (20.5) and 16.3 (24.5) among controls (P <.01). Office visits, tests, and procedures represented the majority of utilization. During the postdiagnosis period, the mean per-patient per-month costs for outpatient services among FM cases was $377 ($760) and $217 ($740.87) among controls (P <.01). CONCLUSION: FM cases had significantly higher utilization and costs compared with controls. Office visits, tests and procedures, and the use of pain-related medications accounted for the largest absolute differences between the 2 groups.

Original languageEnglish
JournalThe American journal of managed care
Volume16
Issue number5 Suppl
StatePublished - May 1 2010

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Fibromyalgia
Office Visits
Ambulatory Care
Health Care Costs
Costs and Cost Analysis
Pain
Propensity Score
International Classification of Diseases
Insurance Benefits
Opioid Analgesics
Research Design
Control Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Palacio, A. M., Uribe, C. L., Li, H., Hanna, J., Deminski, M., Alvir, J., ... Sanchez, R. (2010). Financial and clinical characteristics of fibromyalgia: a case-control comparison. The American journal of managed care, 16(5 Suppl).

Financial and clinical characteristics of fibromyalgia : a case-control comparison. / Palacio, Ana M; Uribe, Claudia L.; Li, Hua; Hanna, John; Deminski, Michael; Alvir, Jose; Chandran, Arthi; Sanchez, Robert.

In: The American journal of managed care, Vol. 16, No. 5 Suppl, 01.05.2010.

Research output: Contribution to journalArticle

Palacio, AM, Uribe, CL, Li, H, Hanna, J, Deminski, M, Alvir, J, Chandran, A & Sanchez, R 2010, 'Financial and clinical characteristics of fibromyalgia: a case-control comparison.', The American journal of managed care, vol. 16, no. 5 Suppl.
Palacio, Ana M ; Uribe, Claudia L. ; Li, Hua ; Hanna, John ; Deminski, Michael ; Alvir, Jose ; Chandran, Arthi ; Sanchez, Robert. / Financial and clinical characteristics of fibromyalgia : a case-control comparison. In: The American journal of managed care. 2010 ; Vol. 16, No. 5 Suppl.
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abstract = "OBJECTIVE: To compare healthcare utilization and costs between subjects with and without fibromyalgia (FM) using claims data from a large health benefits company in the United States. STUDY DESIGN: Retrospective cohort. METHODS: We analyzed 24 months of medical and pharmacy claims data comparing healthcare utilization and costs among Humana members diagnosed with FM to a propensity score matched control group without a diagnosis for FM. FM cases were identified as members aged 18 years and older, with at least 2 medical claims for International Classification of Diseases, Ninth Revision, Clinical Modification codes 729.0 and/or 729.1. The first medical claim for FM was utilized as the index date. RESULTS: A total of 9988 FM cases and 9988 controls were included in the analysis. Compared with controls, the use of pain-related medications by FM cases was approximately 2 times higher with opioids being used most commonly. FM cases utilized a mean (SD) of 22.5 (23.9) and 31.1 (26.6) outpatient services per year in the prediagnosis and postdiagnosis periods, respectively, compared with 14.8 (20.5) and 16.3 (24.5) among controls (P <.01). Office visits, tests, and procedures represented the majority of utilization. During the postdiagnosis period, the mean per-patient per-month costs for outpatient services among FM cases was $377 ($760) and $217 ($740.87) among controls (P <.01). CONCLUSION: FM cases had significantly higher utilization and costs compared with controls. Office visits, tests and procedures, and the use of pain-related medications accounted for the largest absolute differences between the 2 groups.",
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