Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with fibromyalgia newly prescribed pregabalin or tricyclic antidepressants

Mugdha Gore, Kei Sing Tai, Arthi Chandran, Gergana Zlateva, Douglas Leslie

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To examine treatment patterns and costs among patients with fibromyalgia prescribed pregabalin or tricyclic antidepressants (TCAs). Methods: Using the LifeLink™ Health Plan Claims Database, patients with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) newly prescribed (index date) TCAs (n=898) were identified and propensity score-matched (PSM) with patients newly prescribed pregabalin (n=898). Pain-related pharmacotherapy, comorbidities, and healthcare resource use/costs were examined during the 12 months, pre-index, and follow-up periods. Results: Both patient groups reported multiple comorbidities and received pain medications in the pre-index and follow-up periods. Among patients prescribed pregabalin, use of non-selective non-steroidal anti-inflammatory drugs (43.3% vs 39.8%), other anticonvulsants (28.6% vs 23.3%), and tetracyclic/miscellaneous antidepressants (28.5% vs 25.8%) significantly decreased, and cyclooxygenase 2 (COX-2) inhibitors (7.7% vs 10.4%), TCAs (4.8% vs 7.9%), and topical agents (10.8% vs 15.1%) increased in the follow-up period (p<0.05). Among patients prescribed TCAs, there were significant decreases in muscle relaxants (42.0% vs 38.4%) and sedative hypnotics (27.4% vs 23.9%), and increases in COX-2 inhibitors (5.8% vs 7.9%) and anticonvulsants (25.1% vs 33.7%; p<0.05). There were increases (p<0.0001) in pharmacy costs in both cohorts and total healthcare costs in the pregabalin cohort from pre-index to follow-up. Median total costs were higher (p<0.05) in the pregabalin group vs TCAs in the pre-index ($$9935 vs $$8771) and follow-up ($$10,689 vs $$8379) periods. Limitations: Despite attempts to address bias through PSM, the higher pre-index costs in the pregabalin cohort suggest a channeling of patients with more severe fibromyalgia to pregabalin. Conclusions: Patients with fibromyalgia prescribed pregabalin or TCAs had multiple comorbidities and a sizeable pain medication burden, which increased in the follow-up period for both cohorts. Only 5% of pregabalin initiators had been treated with concomitant TCAs at baseline, suggesting that TCAs were inappropriate for these patients owing to their contraindications.

Original languageEnglish (US)
Pages (from-to)32-44
Number of pages13
JournalJournal of Medical Economics
Volume15
Issue number1
DOIs
StatePublished - Feb 1 2012

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Fibromyalgia
Tricyclic Antidepressive Agents
Delivery of Health Care
Drug Therapy
Comorbidity
Costs and Cost Analysis
Propensity Score
Cyclooxygenase 2 Inhibitors
Pain
Health Care Costs
Anticonvulsants
Pregabalin
International Classification of Diseases
Hypnotics and Sedatives
Antidepressive Agents
Anti-Inflammatory Agents
Databases
Muscles
Health

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

@article{4115a4a3f5e04313a4181e6998052cd6,
title = "Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with fibromyalgia newly prescribed pregabalin or tricyclic antidepressants",
abstract = "Objective: To examine treatment patterns and costs among patients with fibromyalgia prescribed pregabalin or tricyclic antidepressants (TCAs). Methods: Using the LifeLink™ Health Plan Claims Database, patients with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) newly prescribed (index date) TCAs (n=898) were identified and propensity score-matched (PSM) with patients newly prescribed pregabalin (n=898). Pain-related pharmacotherapy, comorbidities, and healthcare resource use/costs were examined during the 12 months, pre-index, and follow-up periods. Results: Both patient groups reported multiple comorbidities and received pain medications in the pre-index and follow-up periods. Among patients prescribed pregabalin, use of non-selective non-steroidal anti-inflammatory drugs (43.3{\%} vs 39.8{\%}), other anticonvulsants (28.6{\%} vs 23.3{\%}), and tetracyclic/miscellaneous antidepressants (28.5{\%} vs 25.8{\%}) significantly decreased, and cyclooxygenase 2 (COX-2) inhibitors (7.7{\%} vs 10.4{\%}), TCAs (4.8{\%} vs 7.9{\%}), and topical agents (10.8{\%} vs 15.1{\%}) increased in the follow-up period (p<0.05). Among patients prescribed TCAs, there were significant decreases in muscle relaxants (42.0{\%} vs 38.4{\%}) and sedative hypnotics (27.4{\%} vs 23.9{\%}), and increases in COX-2 inhibitors (5.8{\%} vs 7.9{\%}) and anticonvulsants (25.1{\%} vs 33.7{\%}; p<0.05). There were increases (p<0.0001) in pharmacy costs in both cohorts and total healthcare costs in the pregabalin cohort from pre-index to follow-up. Median total costs were higher (p<0.05) in the pregabalin group vs TCAs in the pre-index ($$9935 vs $$8771) and follow-up ($$10,689 vs $$8379) periods. Limitations: Despite attempts to address bias through PSM, the higher pre-index costs in the pregabalin cohort suggest a channeling of patients with more severe fibromyalgia to pregabalin. Conclusions: Patients with fibromyalgia prescribed pregabalin or TCAs had multiple comorbidities and a sizeable pain medication burden, which increased in the follow-up period for both cohorts. Only 5{\%} of pregabalin initiators had been treated with concomitant TCAs at baseline, suggesting that TCAs were inappropriate for these patients owing to their contraindications.",
author = "Mugdha Gore and Tai, {Kei Sing} and Arthi Chandran and Gergana Zlateva and Douglas Leslie",
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Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with fibromyalgia newly prescribed pregabalin or tricyclic antidepressants. / Gore, Mugdha; Tai, Kei Sing; Chandran, Arthi; Zlateva, Gergana; Leslie, Douglas.

In: Journal of Medical Economics, Vol. 15, No. 1, 01.02.2012, p. 32-44.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with fibromyalgia newly prescribed pregabalin or tricyclic antidepressants

AU - Gore, Mugdha

AU - Tai, Kei Sing

AU - Chandran, Arthi

AU - Zlateva, Gergana

AU - Leslie, Douglas

PY - 2012/2/1

Y1 - 2012/2/1

N2 - Objective: To examine treatment patterns and costs among patients with fibromyalgia prescribed pregabalin or tricyclic antidepressants (TCAs). Methods: Using the LifeLink™ Health Plan Claims Database, patients with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) newly prescribed (index date) TCAs (n=898) were identified and propensity score-matched (PSM) with patients newly prescribed pregabalin (n=898). Pain-related pharmacotherapy, comorbidities, and healthcare resource use/costs were examined during the 12 months, pre-index, and follow-up periods. Results: Both patient groups reported multiple comorbidities and received pain medications in the pre-index and follow-up periods. Among patients prescribed pregabalin, use of non-selective non-steroidal anti-inflammatory drugs (43.3% vs 39.8%), other anticonvulsants (28.6% vs 23.3%), and tetracyclic/miscellaneous antidepressants (28.5% vs 25.8%) significantly decreased, and cyclooxygenase 2 (COX-2) inhibitors (7.7% vs 10.4%), TCAs (4.8% vs 7.9%), and topical agents (10.8% vs 15.1%) increased in the follow-up period (p<0.05). Among patients prescribed TCAs, there were significant decreases in muscle relaxants (42.0% vs 38.4%) and sedative hypnotics (27.4% vs 23.9%), and increases in COX-2 inhibitors (5.8% vs 7.9%) and anticonvulsants (25.1% vs 33.7%; p<0.05). There were increases (p<0.0001) in pharmacy costs in both cohorts and total healthcare costs in the pregabalin cohort from pre-index to follow-up. Median total costs were higher (p<0.05) in the pregabalin group vs TCAs in the pre-index ($$9935 vs $$8771) and follow-up ($$10,689 vs $$8379) periods. Limitations: Despite attempts to address bias through PSM, the higher pre-index costs in the pregabalin cohort suggest a channeling of patients with more severe fibromyalgia to pregabalin. Conclusions: Patients with fibromyalgia prescribed pregabalin or TCAs had multiple comorbidities and a sizeable pain medication burden, which increased in the follow-up period for both cohorts. Only 5% of pregabalin initiators had been treated with concomitant TCAs at baseline, suggesting that TCAs were inappropriate for these patients owing to their contraindications.

AB - Objective: To examine treatment patterns and costs among patients with fibromyalgia prescribed pregabalin or tricyclic antidepressants (TCAs). Methods: Using the LifeLink™ Health Plan Claims Database, patients with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) newly prescribed (index date) TCAs (n=898) were identified and propensity score-matched (PSM) with patients newly prescribed pregabalin (n=898). Pain-related pharmacotherapy, comorbidities, and healthcare resource use/costs were examined during the 12 months, pre-index, and follow-up periods. Results: Both patient groups reported multiple comorbidities and received pain medications in the pre-index and follow-up periods. Among patients prescribed pregabalin, use of non-selective non-steroidal anti-inflammatory drugs (43.3% vs 39.8%), other anticonvulsants (28.6% vs 23.3%), and tetracyclic/miscellaneous antidepressants (28.5% vs 25.8%) significantly decreased, and cyclooxygenase 2 (COX-2) inhibitors (7.7% vs 10.4%), TCAs (4.8% vs 7.9%), and topical agents (10.8% vs 15.1%) increased in the follow-up period (p<0.05). Among patients prescribed TCAs, there were significant decreases in muscle relaxants (42.0% vs 38.4%) and sedative hypnotics (27.4% vs 23.9%), and increases in COX-2 inhibitors (5.8% vs 7.9%) and anticonvulsants (25.1% vs 33.7%; p<0.05). There were increases (p<0.0001) in pharmacy costs in both cohorts and total healthcare costs in the pregabalin cohort from pre-index to follow-up. Median total costs were higher (p<0.05) in the pregabalin group vs TCAs in the pre-index ($$9935 vs $$8771) and follow-up ($$10,689 vs $$8379) periods. Limitations: Despite attempts to address bias through PSM, the higher pre-index costs in the pregabalin cohort suggest a channeling of patients with more severe fibromyalgia to pregabalin. Conclusions: Patients with fibromyalgia prescribed pregabalin or TCAs had multiple comorbidities and a sizeable pain medication burden, which increased in the follow-up period for both cohorts. Only 5% of pregabalin initiators had been treated with concomitant TCAs at baseline, suggesting that TCAs were inappropriate for these patients owing to their contraindications.

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