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Health care use remains high in patients with FM after treatment
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Utilization of the health care system remained high for patients with fibromyalgia after initiating treatment with either amitriptyline, Cymbalta, Neurontin or Lyrica, according to researchers from Brigham and Women’s Hospital.
Claims data were studied to identify 116,183 patients with one or more diagnoses of fibromyalgia (FM) between Jan. 1, 2007, and Dec. 31, 2009, using ICD-9 codes. Eligible patients were older than 18 years of age and had been enrolled with the insurer for at least 180 days before initiation of four treatment drugs included in the study.
Patients taking amitriptyline, Cymbalta (duloxetine, Eli Lilly), Neurontin (gabapentin, Pfizer) or Lyrica (pregabalin, Pfizer) were matched with patients prescribed pregabalin to compare outcomes of health care utilization. The researchers identified 13,404 patients prescribed amitriptyline, 18,420 prescribed duloxetine, 23,268 prescribed gabapentin and 19,286 prescribed pregabalin. Among those patients, 8,269 patients taking amitriptyline, 9,941 taking duloxetine and 18,613 taking gabapentin were matched with patients taking pregabalin on their propensity score at a 1:1 ratio.
Baseline factors were adjusted for health care utilization factors, and the researchers used multivariate Cox models to estimate rate ratios for emergency department (ED) visits, acute care hospitalization and physical therapy during follow-up. Multivariate Poisson regression was used to estimate rate ratios for outpatient visits to any physician, primary-care physicians, specialists and the number of prescribed drugs during follow-up among each of the three propensity score-matched pairs.
Throughout the 180-day baseline period, the frequency of health care utilization and the number of prescribed drugs were high, according to the researchers, with an average of seven to nine physician visits and receipt of eight prescriptions.
The number of outpatient visits, more than one hospitalization and prescriptions decreased slightly after treatment, but the proportion of patients with more than one ED or physical therapy visit increased in all groups.
In multivariate Cox and Poisson regression, fewer outpatient visits were seen in patients prescribed duloxetine compared to the pregabalin group. In the amitriptyline group, a significantly lower rate of hospitalization was seen. The researchers found few differences were seen between the gabapentin and pregabalin groups. – by Shirley Pulawski
Disclosure: Kim is supported by the NIH grant K23 AR059677. She received a research grant from Pfizer. Please see the full study for a list of all other authors’ relevant financial disclosures.
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