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Impact of fibromyalgia severity on health economic costs

Results from a European cross-sectional study

  • Original Research Article
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Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

Fibromyalgia (FM) is a chronic disorder characterized by persistent and widespread pain, often accompanied with fatigue, sleep disturbance and other symptoms. FM affects a population mostly of a productive age and is thus associated with significant lost productivity and disability, in addition to healthcare costs for medications and physician office visits. While other studies have examined FM costs in Europe, few, if any, have examined cost by FM severity level.

Objective

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.

Methods

A total of 299 patients with FM, previously diagnosed by a rheumatologist, were recruited from physician offices in France and Germany during routine visits. Subjects completed questions about their pain, health-related quality of life, treatment satisfaction, productivity and FM-related out-of-pocket expenses; site staff recorded clinical, treatment and HRU information for the previous 3 months based on a review of medical records. FM severity was defined using subjects’ Fibromyalgia Impact Questionnaire (FIQ) total scores. Annual costs from a societal perspective were calculated in h, year 2008 values, and included direct costs (e.g. physician office visits, medications, out-of-pocket expenses) and indirect costs (e.g. missed days of work and lost productivity). The mean annual costs were calculated based on 3-month data.

Results

Subjects were reported to have a mean (SD) of 2.9 (1.9) physician office visits in France and 4.9 (3.2) visits in Germany over the past 3 months, corresponding to an average of 11.6 and 19.6 visits a year, respectively. A total of 91% of subjects were receiving prescription medication for their FM. French subjects reported a lower use of anti-inflammatories (39% of subjects) and a higher use of other analgesics (59% of subjects) than German subjects (67% and 34%, respectively). Subjects in full- or part-time employment reported missing a mean (SD) of 2.7 (6.0) days of work due to FM in France and 2.1 (3.8) days in Germany over the last 4 weeks (corresponding to 32.4 and 25.2 days of work missed due to FM per year in France and Germany, respectively). In France, total costs were €7900 (direct €910, indirect €6990). In Germany, total costs were €7256 (direct €1765, indirect €5491). A trend of higher total costs was seen as FM severity increased; however, the results were significant (p = 0.003) only for Germany.

Conclusions

FM imposes a significant economic burden on society. Consistent with other studies, FM subjects were found to have substantial costs, over 75% of which were driven by indirect costs from lost productivity. These costs increased as FM severity increased, resulting in a more than 200% difference in cost between mild and severe FM. Overall FM costs were similar between France and Germany; although lost productivity accounted for a higher proportion of costs in France.

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Notes

  1. Key elements of the ACR criteria are chronic widespread pain for at least 3 months and tenderness in at least 11 of 18 tender point sites, which is measured by applying approximately 4 kg of pressure at each of the 18 sites.

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Acknowledgements

This study was funded by Pfizer, Inc. Arthi Chandran, Alesia Sadosky and Gergana Zlateva are employees of Pfizer Inc. Caroline Schaefer and Kellie Ryan are employees of Covance Market Access Services Inc., and served as paid consultants to Pfizer, Inc for the duration of this study and the development of this manuscript. Andreas Winkelmann is an employee of University Hospital Munich and Serge Perrot is an employee of Hôtel Dieu Hospital. The authors thank the principal investigators who participated in this study: Dr Lydia Arabian, Dr Michel Behar, Dr Marie-Laure Berges, Dr Jean-Claude Cooren, Dr Benoît Daguzan, Dr Daniel Delbecq, Dr Danièle Delbeque, Dr Irene Ernst, Dr Alezandre D’Eszlary, Dr Robert Franz, Dr Gérard Forcada, Dr Nils Graf Stenbock-Fermor, Dr Joël Hautin, Dr Michel Hoze, Dr Paul Jansco, Dr Thomas Jung, Dr Peter Lauer, Dr Joel Manczak, Dr Denis Marin, Dr Jacques Marty, Dr Elie Moatti, Dr Otmar Müller, Dr Jérôme Nuel, Dr Serge Perrot, Dr Didier Roche, Dr Petra Sandow, Dr Ingo Senftleber, Dr Jörg Simon, Dr Wolfgang Sohn, Dr Uwe Speier, Dr Philippe Tauveron, Dr Jachim Weimer, Dr Burkhard Wiedeking, Dr Andreas Winkelmann and Dr Hans-Werner Wozny.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, University Hospital Munich, Munich, Germany

    Andreas Winkelmann

  2. Department of Internal Medicine and Therapeutics, Pain Consultation, Hôtel Dieu Hospital, University of Paris, Descartes, Paris, France

    Serge Perrot

  3. Covance Market Access Services Inc., 9801 Washingtonian Boulevard, Ninth Floor, Gaithersburg, MD, 20878-5355, USA

    Caroline Schaefer (Vice President) & Kellie Ryan

  4. Pfizer Global Health Economics, New York, New York, USA

    Arthi Chandran, Alesia Sadosky & Gergana Zlateva

Authors
  1. Andreas Winkelmann
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  2. Serge Perrot
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  3. Caroline Schaefer
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  4. Kellie Ryan
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  5. Arthi Chandran
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  6. Alesia Sadosky
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  7. Gergana Zlateva
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Corresponding author

Correspondence to Caroline Schaefer.

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Winkelmann, A., Perrot, S., Schaefer, C. et al. Impact of fibromyalgia severity on health economic costs. Appl Health Econ Health Policy 9, 125–136 (2011). https://doi.org/10.2165/11535250-000000000-00000

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