TY - JOUR
T1 - Patterns of health care utilization related to initiation of amitriptyline, duloxetine, gabapentin, or pregabalin in fibromyalgia
AU - Kim, Seoyoung C.
AU - Landon, Joan E.
AU - Lee, Yvonne C.
N1 - Funding Information:
This study was supported by an investigator-initiated grant from Pfizer. Pfizer had no role in the study design, data collection, data analysis, or writing of the manuscript, nor did it have a role in approval of the content of the submitted manuscript. Publication of this article was not contingent on the approval of Pfizer. The study was conducted by the authors independently of the sponsor. The sponsor was given the opportunity to make nonbinding comments on a draft of the manuscript, but the authors retained the right of publication and to determine the final wording of the article. YCL received research grants from Forest. She holds stock in Cubist, Merck, Perrigo, and Express Scripts. SCK received a research grant from Forest. JEL has no competing interests. None of the authors had any nonfinancial competing interests related to this study.
Funding Information:
This study was supported by an investigator-initiated grant from Pfizer. SCK is supported by National Institutes of Health (NIH) grant K23 AR059677 and a research grant from Pfizer. YCL is supported by NIH grants K23 AR57578 and R01 AR064850 and a research grant from Forest.
Publisher Copyright:
© 2015 Kim et al.
PY - 2015/1/28
Y1 - 2015/1/28
N2 - Introduction: Several pharmacologic treatments are available for fibromyalgia, but little is known about the comparative effectiveness of these treatments on health care utilization. Methods: Using US commercial insurance claims data (covering 2007 to 2009), we conducted a cohort study to examine the comparative effectiveness of amitriptyline, duloxetine, gabapentin, and pregabalin on health care utilization in patients with fibromyalgia. We measured patients' medication adherence using the proportion of days covered (PDC) and estimated multivariable rate ratios (RRs) for outpatient visits, prescriptions, hospitalization, and emergency department (ED) visits in propensity score (PS)-matched cohorts. Results: Cohorts of 8,269 amitriptyline, 9,941 duloxetine, and 18,613 gabapentin initiators were compared with their PS-matched pregabalin initiators. During the baseline 180-day period, patients had, on average, seven to nine physician visits, including six to eight specialist visits, and received eight prescription drugs. The mean PDC up to 180 days varied from 38.6% to 67.7%. The number of outpatient visits, prescriptions, and hospitalizations decreased slightly after initiating one of the study drugs, but the number of ED visits increased after treatment initiation. Compared to pregabalin, duloxetine was associated with decreased outpatient visits (RR, 0.94. 95% confidence interval (CI), 0.88 to 1.00), prescriptions (RR, 0.94. 95% CI, 0.90 to 0.98), hospitalizations (RR, 0.75. 95% CI, 0.68 to 0.83), and ED visits (RR, 0.85. 95% CI, 0.79 to 0.91). Little difference in health care utilization rates was noted among amitriptyline and gabapentin initiators compared to those who were started on pregabalin. Conclusions: Fibromyalgia patients had high health care utilization before and after initiation of amitriptyline, duloxetine, gabapentin, or pregabalin. Medication adherence was suboptimal. Overall, fibromyalgia treatment had little impact on reducing health care utilization, but duloxetine initiators had less health care utilization than those started on pregabalin.
AB - Introduction: Several pharmacologic treatments are available for fibromyalgia, but little is known about the comparative effectiveness of these treatments on health care utilization. Methods: Using US commercial insurance claims data (covering 2007 to 2009), we conducted a cohort study to examine the comparative effectiveness of amitriptyline, duloxetine, gabapentin, and pregabalin on health care utilization in patients with fibromyalgia. We measured patients' medication adherence using the proportion of days covered (PDC) and estimated multivariable rate ratios (RRs) for outpatient visits, prescriptions, hospitalization, and emergency department (ED) visits in propensity score (PS)-matched cohorts. Results: Cohorts of 8,269 amitriptyline, 9,941 duloxetine, and 18,613 gabapentin initiators were compared with their PS-matched pregabalin initiators. During the baseline 180-day period, patients had, on average, seven to nine physician visits, including six to eight specialist visits, and received eight prescription drugs. The mean PDC up to 180 days varied from 38.6% to 67.7%. The number of outpatient visits, prescriptions, and hospitalizations decreased slightly after initiating one of the study drugs, but the number of ED visits increased after treatment initiation. Compared to pregabalin, duloxetine was associated with decreased outpatient visits (RR, 0.94. 95% confidence interval (CI), 0.88 to 1.00), prescriptions (RR, 0.94. 95% CI, 0.90 to 0.98), hospitalizations (RR, 0.75. 95% CI, 0.68 to 0.83), and ED visits (RR, 0.85. 95% CI, 0.79 to 0.91). Little difference in health care utilization rates was noted among amitriptyline and gabapentin initiators compared to those who were started on pregabalin. Conclusions: Fibromyalgia patients had high health care utilization before and after initiation of amitriptyline, duloxetine, gabapentin, or pregabalin. Medication adherence was suboptimal. Overall, fibromyalgia treatment had little impact on reducing health care utilization, but duloxetine initiators had less health care utilization than those started on pregabalin.
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U2 - 10.1186/s13075-015-0530-8
DO - 10.1186/s13075-015-0530-8
M3 - Article
C2 - 25627453
AN - SCOPUS:84924297256
SN - 1478-6354
VL - 17
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
IS - 1
M1 - 18
ER -