Healthcare utilization and costs for insured patients with fibromyalgia

Objectives: To identify patterns of change in healthcare utilization and costs during the year before and after diagnosis of fibromyalgia. Methods: Fibromyalgia patients aged ≥18 years with at least 2 medical claims for International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1 between June 1, 2002, and March 1, 2007, were identified. Prevalence of comorbidities, pharmacotherapy, and healthcare resource use/costs (pharmacy, outpatient, emergency department, inpatient) were examined during the 12 months preceding (preindex) and following (postindex) the date of first fibromyalgia diagnosis (index). We further subdivided these periods into four 6-month blocks to better observe patterns of change in utilization. Results: The mean age at diagnosis was 55.4 years; 69% of patients were female. Utilization of all categories of pain-related medications increased during the postdiagnosis period (P <.001). The largest absolute increase was for muscle relaxants, followed by opioids and nonsteroidal anti-inflammatory drugs, with absolute increases of 5.8%, 5.0%, and 4.6%, respectively, from time period -1 to time period +1. In the outpatient setting, per patient per month costs for encounters increased 20% (time period 2 to time period 1), continued to increase through time period +1 (47%), and decreased by 20% during time period +2. A similar pattern of change in costs and healthcare utilization was observed for the other service categories. All changes were statistically significant. Conclusion: After a diagnosis of fibromyalgia, we observed a pattern of increase in utilization and costs up to time period +1 followed by a decrease in time period +2.