Clinical comorbidities, treatment patterns, and healthcare costs among patients with fibromyalgia newly prescribed pregabalin or duloxetine in usual care

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

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: To assess comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with fibromyalgia (FM) newly prescribed pregabalin or duloxetine (index event) in usual care settings. Methods: Using the LifeLink™ Health Plan Claims Database, patients with FM (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) were identified. Patients initiated on duloxetine were propensity score-matched with patients initiated on pregabalin (n=826; mean age [standard deviation] of 48.3 [9.3] years for both groups). Prevalence of comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. Results: Both patient groups had multiple comorbidities and a substantial pain-related and adjuvant medication burden. In the pregabalin group, use of other anticonvulsants decreased significantly (31.6% vs 24.9%), whereas use of serotonin-norepinephrine reuptake inhibitors (SNRIs; 16.5% vs 22.5%) and topical agents (10.1% vs 13.2%) increased in the follow-up period (p<0.01). In the duloxetine group, there were significant decreases in the use of other SNRIs (13.0% vs 5.7%), selective serotonin reuptake inhibitors (41.3% vs 21.7%), and tricyclic antidepressants (18.8% vs 13.2%), and an increase in the use of anticonvulsants (28.6% vs 40.1%; p<0.0001). There were significant increases (p<0.0001) in pharmacy and total healthcare costs in both cohorts, and a significant increase in outpatient costs (p=0.0084) in the duloxetine cohort from pre-index to follow-up. There were no significant differences in median total healthcare costs between the pregabalin and duloxetine groups in both the pre-index ($$10,159 vs $$9,556) and follow-up ($$11,390 vs $$11,746) periods. Limitations: Limitations of this study are typical of those associated with retrospective database analyses. Conclusions: Patients with FM prescribed pregabalin or duloxetine were characterized by a significant comorbidity and pain/adjuvant medication burden. Although healthcare costs increased in both groups, there were no statistically significant differences in direct healthcare costs between the two groups.

Original languageEnglish (US)
Pages (from-to)19-31
Number of pages13
JournalJournal of Medical Economics
Volume15
Issue number1
DOIs
StatePublished - Feb 1 2012

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Fibromyalgia
Health Care Costs
Comorbidity
Pain
Anticonvulsants
Databases
Delivery of Health Care
Costs and Cost Analysis
Drug Therapy
Propensity Score
Tricyclic Antidepressive Agents
Serotonin Uptake Inhibitors
International Classification of Diseases
Pregabalin
Duloxetine Hydrochloride
Outpatients
Health
Serotonin and Noradrenaline Reuptake Inhibitors

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

@article{7b9deffa17684e44b76f86c70b8595ea,
title = "Clinical comorbidities, treatment patterns, and healthcare costs among patients with fibromyalgia newly prescribed pregabalin or duloxetine in usual care",
abstract = "Objective: To assess comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with fibromyalgia (FM) newly prescribed pregabalin or duloxetine (index event) in usual care settings. Methods: Using the LifeLink™ Health Plan Claims Database, patients with FM (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) were identified. Patients initiated on duloxetine were propensity score-matched with patients initiated on pregabalin (n=826; mean age [standard deviation] of 48.3 [9.3] years for both groups). Prevalence of comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. Results: Both patient groups had multiple comorbidities and a substantial pain-related and adjuvant medication burden. In the pregabalin group, use of other anticonvulsants decreased significantly (31.6{\%} vs 24.9{\%}), whereas use of serotonin-norepinephrine reuptake inhibitors (SNRIs; 16.5{\%} vs 22.5{\%}) and topical agents (10.1{\%} vs 13.2{\%}) increased in the follow-up period (p<0.01). In the duloxetine group, there were significant decreases in the use of other SNRIs (13.0{\%} vs 5.7{\%}), selective serotonin reuptake inhibitors (41.3{\%} vs 21.7{\%}), and tricyclic antidepressants (18.8{\%} vs 13.2{\%}), and an increase in the use of anticonvulsants (28.6{\%} vs 40.1{\%}; p<0.0001). There were significant increases (p<0.0001) in pharmacy and total healthcare costs in both cohorts, and a significant increase in outpatient costs (p=0.0084) in the duloxetine cohort from pre-index to follow-up. There were no significant differences in median total healthcare costs between the pregabalin and duloxetine groups in both the pre-index ($$10,159 vs $$9,556) and follow-up ($$11,390 vs $$11,746) periods. Limitations: Limitations of this study are typical of those associated with retrospective database analyses. Conclusions: Patients with FM prescribed pregabalin or duloxetine were characterized by a significant comorbidity and pain/adjuvant medication burden. Although healthcare costs increased in both groups, there were no statistically significant differences in direct healthcare costs between the two groups.",
author = "Mugdha Gore and Tai, {Kei Sing} and Arthi Chandran and Gergana Zlateva and Douglas Leslie",
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Clinical comorbidities, treatment patterns, and healthcare costs among patients with fibromyalgia newly prescribed pregabalin or duloxetine in usual care. / Gore, Mugdha; Tai, Kei Sing; Chandran, Arthi; Zlateva, Gergana; Leslie, Douglas.

In: Journal of Medical Economics, Vol. 15, No. 1, 01.02.2012, p. 19-31.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical comorbidities, treatment patterns, and healthcare costs among patients with fibromyalgia newly prescribed pregabalin or duloxetine in usual care

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 assess comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with fibromyalgia (FM) newly prescribed pregabalin or duloxetine (index event) in usual care settings. Methods: Using the LifeLink™ Health Plan Claims Database, patients with FM (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) were identified. Patients initiated on duloxetine were propensity score-matched with patients initiated on pregabalin (n=826; mean age [standard deviation] of 48.3 [9.3] years for both groups). Prevalence of comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. Results: Both patient groups had multiple comorbidities and a substantial pain-related and adjuvant medication burden. In the pregabalin group, use of other anticonvulsants decreased significantly (31.6% vs 24.9%), whereas use of serotonin-norepinephrine reuptake inhibitors (SNRIs; 16.5% vs 22.5%) and topical agents (10.1% vs 13.2%) increased in the follow-up period (p<0.01). In the duloxetine group, there were significant decreases in the use of other SNRIs (13.0% vs 5.7%), selective serotonin reuptake inhibitors (41.3% vs 21.7%), and tricyclic antidepressants (18.8% vs 13.2%), and an increase in the use of anticonvulsants (28.6% vs 40.1%; p<0.0001). There were significant increases (p<0.0001) in pharmacy and total healthcare costs in both cohorts, and a significant increase in outpatient costs (p=0.0084) in the duloxetine cohort from pre-index to follow-up. There were no significant differences in median total healthcare costs between the pregabalin and duloxetine groups in both the pre-index ($$10,159 vs $$9,556) and follow-up ($$11,390 vs $$11,746) periods. Limitations: Limitations of this study are typical of those associated with retrospective database analyses. Conclusions: Patients with FM prescribed pregabalin or duloxetine were characterized by a significant comorbidity and pain/adjuvant medication burden. Although healthcare costs increased in both groups, there were no statistically significant differences in direct healthcare costs between the two groups.

AB - Objective: To assess comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with fibromyalgia (FM) newly prescribed pregabalin or duloxetine (index event) in usual care settings. Methods: Using the LifeLink™ Health Plan Claims Database, patients with FM (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) were identified. Patients initiated on duloxetine were propensity score-matched with patients initiated on pregabalin (n=826; mean age [standard deviation] of 48.3 [9.3] years for both groups). Prevalence of comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. Results: Both patient groups had multiple comorbidities and a substantial pain-related and adjuvant medication burden. In the pregabalin group, use of other anticonvulsants decreased significantly (31.6% vs 24.9%), whereas use of serotonin-norepinephrine reuptake inhibitors (SNRIs; 16.5% vs 22.5%) and topical agents (10.1% vs 13.2%) increased in the follow-up period (p<0.01). In the duloxetine group, there were significant decreases in the use of other SNRIs (13.0% vs 5.7%), selective serotonin reuptake inhibitors (41.3% vs 21.7%), and tricyclic antidepressants (18.8% vs 13.2%), and an increase in the use of anticonvulsants (28.6% vs 40.1%; p<0.0001). There were significant increases (p<0.0001) in pharmacy and total healthcare costs in both cohorts, and a significant increase in outpatient costs (p=0.0084) in the duloxetine cohort from pre-index to follow-up. There were no significant differences in median total healthcare costs between the pregabalin and duloxetine groups in both the pre-index ($$10,159 vs $$9,556) and follow-up ($$11,390 vs $$11,746) periods. Limitations: Limitations of this study are typical of those associated with retrospective database analyses. Conclusions: Patients with FM prescribed pregabalin or duloxetine were characterized by a significant comorbidity and pain/adjuvant medication burden. Although healthcare costs increased in both groups, there were no statistically significant differences in direct healthcare costs between the two groups.

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