Out-of-pocket medical and prescription drug costs for fibromyalgia patients compared with patients with other chronic conditions

Objectives: Fibromyalgia (FM) is a chronic condition characterized by multiple symptoms such as pain, fatigue, cognitive dysfunction, and decreased physical function. This study compares mean annual out-of-pocket medical and prescription drug costs per patient for patients diagnosed with FM with those for patients diagnosed with Major Depressive Disorder and other Depressive Disorders (DEP) and with those for patients diagnosed with Chronic Fatigue Syndrome (CFS).

Methods: Using a large US health insurance database, we identified all patients aged 18+ years with continuous health plan eligibility and ≥1 inpatient or ≥2 outpatient paid medical and prescription drug claims during calendar year 2006 with ICD-9-CM codes for one of the disease conditions. Patient groups were not mutually exclusive (10.8% of FM patients had DEP and 1.0% had CFS). For each disease condition, mean annual costs per patient were calculated using patient out-of-pocket expenditures associated with all paid health insurance claims in 2006, regardless of diagnosis. Expenditures not involving an insurance claim (eg, over-the-counter drugs) were not included. Incremental costs relative to FM were generated using generalized linear models (family=gamma, link=log), adjusting for age, gender, beneficiary status, employment status, insurance plan type, and comorbid prevalence of FM, DEP, CFS, and other conditions.

Results: A total of 77,124 FM, 11,672 CFS and 215,380 DEP patients met all study entry criteria. Total mean annual unadjusted out-of-pocket costs per patient were higher for FM patients ($1,540) than for DEP patients ($1,449) and CFS patients ($1,219). The highest unadjusted cost category for all three conditions was outpatient care (FM $900; DEP $777; CFS $732). Physician office visits (FM $503; DEP $449; CFS $418) accounted for most outpatient costs. The second highest unadjusted cost category was prescription drugs (FM $516; DEP $499; CFS $418), followed by inpatient care (FM $124; DEP $173; CFS $89). After adjusting for covariates, out-of-pocket costs for FM patients were 5.3% ($77) lower than costs for DEP patients and were 7.7% ($99) higher than costs for CFS patients.

Conclusions: Out-of-pocket costs for patients with FM are comparable to those for patients with DEP or CFS, which are chronic diseases with symptoms similar to FM. The impact of out-of-pocket expenditures on quality of care should be further investigated since these expenditures may affect whether patients are able to obtain necessary care.