Cost of Fibromyalgia
Societal Costs of Fibromyalgia
Much of the research regarding the costs associated with fibromyalgia has been conducted in relation to the impact fibromyalgia has on disability and impaired job performance. Such research has shown that these costs to society and the workforce result in substantially impaired job performance and significant job loss among fibromyalgia patients (Wallace 1997; Greenfield et al., 1992; Kaplan et al., 2000). Nearly half of the economic loss attributable to fibromyalgia is the result of work loss. The rate of absenteeism among fibromyalgia patients is nearly two times greater than that of average healthy employees, and when those patients with co-morbid depression are considered specifically, this rate increases to 3.4 times (Evans et al., 2006).
Patient Costs Associated with Fibromyalgia
More recent research has focused on the acute monetary impact of fibromyalgia on patients, employers, and society; however, the available data is limited, and the information that is available differs between sources. For example, to determine the costs associated with fibromyalgia, some studies have analyzed large databases of patients while others have produced estimates based on small samples of patients. In addition, the tools and methods used to assess and determine costs frequently vary between studies. Some studies have utilized questionnaires to assess healthcare resource utilization, a method that my not reflect actual patterns of use, and many studies were conducted in the 1990s and do not reflect current costs of care. Furthermore, results are difficult to compare between studies due to inherent differences in the medical systems of various countries (Spaeth 2009; Berger et al., 2007). Nevertheless, cost data is available and on the whole, indicates that fibromyalgia patients, employers, insurers, and society experience a disproportionate cost burden due to fibromyalgia. In addition, detailed analyses of patient factors and cost data have shown that patient co-morbidities, degree of disability, and disease severity are the factors that contribute the most significantly to the costs associated with fibromyalgia (Evans et al., 2006). However, patients should always use a systematized process to track their treatments relative to the impact they have on specific symptoms. Doing so will help to minimize unnecessary costs due to ongoing use of ineffective treatments.
In general, most studies have found that fibromyalgia patients incur direct medical costs that are approximately two- to three-times that of otherwise healthy individuals (Thompson et al., 2011; Berger et al., 2007). Based on findings from a 2011 study, the yearly direct medical costs per fibromyalgia patient range from $3,400 to $3,600 (Sanchez et al., 2011; CDC 2011). These charges are primarily due to the cost of medical office and emergency room visits, procedures and testing, and hospitalizations. Earlier estimates from 1997 found that the total direct and indirect costs related to fibromyalgia were approximately $5,945 per patient (Wolfe et al., 1997). A 2003 survey found that average direct and indirect costs of $4,533. A recent study of healthcare utilization among fibromyalgia patients in Germany and France found that fibromyalgia patients had substantially increased costs of non-patients, 75% of which were due to the indirect costs associated with lost productivity. In addition, these costs were found to increase in relation to increasing fibromyalgia severity (Winkelmann et al., 2011).
Costs Not Covered by Insurance
A multi-disciplinary approach to treating fibromyalgia is the best option for most patients, therefore complementary and alternative medicine (CAM) therapies are often pursued by fibromyalgia patients in addition to standard medical therapy. Although exceptions can be found, many standard insurance plans do not cover these CAM therapies, such as massage therapy, exercise interventions, dietary counseling, acupuncture, and chiropractic. Nevertheless, research has shown that CAM therapies may provide an economical alternative for many fibromyalgia patients (Lind et al., 2007). Patients should always consult their insurance company prior to initiating any specific CAM therapy in order to obtain information about coverage (if available) and to avoid unwanted out-of-pocket expenses.
Cost-effectiveness of Specific Fibromyalgia Therapies
A number of studies have assessed the cost-effectiveness of several medications recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. Lloyd et al., found that patients who completed 12 weeks of treatment with pregabalin (Lyrica) experienced significant cost-savings over the course of the following year, when compared to those who received a placebo. The authors concluded that their data support the assertion that Lyrica is cost-effective for treating patients with severe fibromyalgia (Lloyd et al., 2012). Additional research has also found similar results related to the cost-effectiveness and efficacy of Lyrica when compared to placebo and duloxetine (Cymbalta) for treating severe fibromyalgia pain (Choy et al., 2010); however, Cymbalta has also been found in one study to be a cost-effective option for treating fibromyalgia-related pain (Beard et al., 2011). In contrast, other studies have found no differences in health-related costs between patients who received Lyrica, Cymbalta, or the conventional antidepressants Effexor and amitriptyline (Kleinman et al., 2011).
In addition to the aforementioned medications, Gusi & Tomas-Carus (2008) found that fibromyalgia patients who participated in a warm-water based physical therapy regimen (in addition to usual fibromyalgia care) received cost-effective benefits in terms of healthcare costs and societal costs. However, the researchers pointed out that facility-specific characteristics, such as the distance required to travel for such therapy) require consideration before deciding to incorporate such therapy into a larger treatment plan on the basis of cost-effectiveness. Studies in this area are limited in number and confounded by small sample sizes, therefore additional research is needed to validate and expand on the findings.