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

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

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


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 (US)
Pages (from-to)S118-125
JournalThe American journal of managed care
Issue number5 Suppl
StatePublished - May 2010

ASJC Scopus subject areas

  • Health Policy


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