Academic journal article Applied Health Economics and Health Policy

Impact of Fibromyalgia Severity on Health Economic Costs

Academic journal article Applied Health Economics and Health Policy

Impact of Fibromyalgia Severity on Health Economic Costs

Article excerpt


Fibromyalgia (FM) presents a substantial healthcare burden to society in clinical, humanistic and economic outcomes. It is a chronic disorder characterized by persistent and widespread pain,[1] and is associated with a number of co-morbid conditions, including fatigue, sleep disturbances, headaches, irritable bowel and bladder, cognitive dysfunction, anxiety and depression.[1-5]

Diagnosing FM can be challenging. FM lacks a definitive diagnostic test; therefore, it is often diagnosed by ruling out other conditions, such as rheumatoid arthritis, lupus and multiple sclerosis.[6] Guidelines exist, such as the American College of Rheumatology (ACR) criteria,1 that are used to assist in diagnosis;[7] however, they are not universally applied. Additionally, a number of FM management guidelines have been published, including those by the American Pain Society,[8] the European League Against Rheumatism[9] and the Association of the Scientific Medical Societies in Germany (AWMF) in collaboration with the German Inter-disciplinary Association of Pain Therapy (DIVS),[10] reflecting that generalized pain does not adequately characterize FM and a broader assessment of pain, function and psychosocial aspects may aid in FM diagnosis and management. FM is estimated to affect up to 6% of the general population in Europe.[11,12] However, given the difficulties associated with diagnosing the condition, it is thought that FM is currently under-diagnosed,[11,12] thus resulting in improper disease management for many FM patients.

Previous research has utilized the Fibromyalgia Impact Questionnaire (FIQ) to define FM severity levels.[13] The FIQ is a validated disease-specific questionnaire that was developed to capture the spectrum of symptoms and problems related to FM.[14] Bennett and colleagues[13,14] defined FIQ cutpoints to indicate mild, moderate and severe impact of FM; however, to date, few studies have examined patient outcomes by FM severity level.

Due in part to the chronic nature of the condition, FM patients are reported as high consumers of healthcare services in Europe.[15-18] The lack of a definitive diagnostic test means that patients may repeatedly present to multiple physicians with various symptoms prior to being diagnosed with FM.[3,19] Once diagnosed, patients often experience suboptimal pain and symptom management involving multiple trials of different prescription drugs and may continue to be high consumers of healthcare services.[3,16]

At the time of this study, there were no products licensed for the treatment or management of FM in Europe. FM management has focused on symptom relief and pain modulation, as well as treatment for co-morbid conditions such as depression, anxiety and fatigue.[8-10] The treatment of FM may be complicated by these co-morbidities, contributing to an inefficient use of resources. Additionally, the co-morbidities associated with FM may increase the potential for misdiagnosis by attributing painful symptoms to other causes. These co-morbidity-related treatment and diagnosis difficulties may lead to high medical and prescription drug costs for individuals with FM.

While other studies have examined costs in Europe, few, if any, have examined cost by FM severity level. Additionally, studies have focused on costs in only one country. The objective of this study was to examine health resource utilization (HRU) and costs associated with FM in routine clinical practice in France and Germany across disease severity levels.


Study Design

This cross-sectional, observational study included FM subjects recruited from 33 community-based physician offices (29 GPs, 3 rheumatologists and 1 orthopaedist) in France and Germany. Since there are no definitive criteria for FM diagnosis, subjects were required to have a prior diagnosis of FM confirmed by a rheumatologist or pain specialist, to have experienced widespread pain (above and below the waist and on both sides of the body) for at least 3 months and to have experienced pain in the past 24 hours. …

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