Abstract
IntroductionSeveral pharmacologic treatments are available for fibromyalgia, but little is known about the comparative effectiveness of these treatments on health care utilization.MethodsUsing US commercial insurance claims data (covering 2007 to 2009), we conducted a cohort study to examine the comparative effectiveness of amitriptyline, duloxetine, gabapentin, and pregabalin on health care utilization in patients with fibromyalgia. We measured patients’ medication adherence using the proportion of days covered (PDC) and estimated multivariable rate ratios (RRs) for outpatient visits, prescriptions, hospitalization, and emergency department (ED) visits in propensity score (PS)–matched cohorts.ResultsCohorts of 8,269 amitriptyline, 9,941 duloxetine, and 18,613 gabapentin initiators were compared with their PS-matched pregabalin initiators. During the baseline 180-day period, patients had, on average, seven to nine physician visits, including six to eight specialist visits, and received eight prescription drugs. The mean PDC up to 180 days varied from 38.6% to 67.7%. The number of outpatient visits, prescriptions, and hospitalizations decreased slightly after initiating one of the study drugs, but the number of ED visits increased after treatment initiation. Compared to pregabalin, duloxetine was associated with decreased outpatient visits (RR, 0.94; 95% confidence interval (CI), 0.88 to 1.00), prescriptions (RR, 0.94; 95% CI, 0.90 to 0.98), hospitalizations (RR, 0.75; 95% CI, 0.68 to 0.83), and ED visits (RR, 0.85; 95% CI, 0.79 to 0.91). Little difference in health care utilization rates was noted among amitriptyline and gabapentin initiators compared to those who were started on pregabalin.ConclusionsFibromyalgia patients had high health care utilization before and after initiation of amitriptyline, duloxetine, gabapentin, or pregabalin. Medication adherence was suboptimal. Overall, fibromyalgia treatment had little impact on reducing health care utilization, but duloxetine initiators had less health care utilization than those started on pregabalin.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0530-8) contains supplementary material, which is available to authorized users.
Highlights
Several pharmacologic treatments are available for fibromyalgia, but little is known about the comparative effectiveness of these treatments on health care utilization
Study cohort Among 116,183 patients who had at least one diagnosis of fibromyalgia between 2007 and 2009, we identified 13,404 amitriptyline, 18,420 duloxetine, 23,268 gabapentin, and 19,286 pregabalin initiators [15]
8,269 amitriptyline, 9,941 duloxetine, and 18,613 gabapentin initiators were matched to pregabalin initiators on their propensity score (PS) with a ratio of 1:1
Summary
Several pharmacologic treatments are available for fibromyalgia, but little is known about the comparative effectiveness of these treatments on health care utilization. In studies comparing pre- and posttreatment, pregabalin initiators had increased inpatient and outpatient visits. Researchers reported increases in total health care costs after initiating treatment with pregabalin or duloxetine for fibromyalgia [10]. In a study comparing pregabalin to TCAs, pregabalin initiators had increased total health care costs from pretreatment to follow-up [14]. All of these studies were performed using US claims data, the effects of fibromyalgia treatment on health care utilization may vary across different health care systems, across different countries
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