Abstract
Duloxetine was recently approved for the management of fibromyalgia, yet no study has examined how it is used empirically. This retrospective study examined predictors of adherence to duloxetine, and the association between adherence and healthcare costs among elderly patients. Medical and pharmacy claims data were analyzed for fibromyalgia patients aged 65+ with Medicare supplemental insurance who initiated duloxetine between 1/1/2006 and 12/31/2006. Initiation of treatment was defined as no duloxetine pill coverage over prior 90 days. Dispense date of the first duloxetine pharmacy claim was deemed as the index date. Patients with pre-existing (prior 12 months) diabetic peripheral neuropathic pain or depression or < 30 day duloxetine supply in the 12-month post-index period were excluded. Two cohorts were constructed based on duloxetine adherence (high adherence as medication possession ratio ≥0.8 measured over 12-month post-index period). Predictors of high adherence were examined via logistic regression. Multivariate regressions were used to assess the association between adherence and healthcare costs. The study included 566 fibromyalgia patients with an average age of 73 years, and 68% having low adherence to duloxetine. Controlling for demographic and clinical characteristics, high average daily dose was associated with increased adherence (Odds ratio=3.08, 2.34, and 4.76 for 31-59mg, 60mg, and >60mg compared with 30mg, respectively, all p<0.05). Controlling for differences in demographics and comorbidities, patients with high adherence had similar total and inpatient costs, but significantly lower outpatient costs (-$1,815, p<0.05) compared with those with low adherence. In conclusion, elderly fibromyalgia patients with higher average daily dose of duloxetine were more likely to adhere to therapy. Patients with high adherence had reduced outpatient healthcare costs. (Funding for this project was provided by Eli Lilly and Company.)
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