Treating patients with fibromyalgia in primary care settings under routine medical practice: a claim database cost and burden of illness study.

INTRODUCTION: The objective of this study was to analyze health care and non-health care resource utilization under routine medical practice in a primary care setting claims database and to estimate the incremental average cost per patient per year of fibromyalgia syndrome (FMS) compared with a reference population. METHODS: A 12-month cross-sectional and retrospective study was completed using computerized medical records from a health provider database. Analyses were conducted from the perspective of the provider and from the viewpoint of society. Health care and non-health care resource utilization included drugs, complementary tests, all types of medical visits, referrals, hospitalizations, sick leave, and early retirement because of disability due to FMS. Patients with a diagnosis of FMS in accordance with ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th revision) criteria were included in the analysis if they had at least one claim for FMS during the 12 months prior to the end of May 2007. A non-FMS comparison group was also created with the remaining subjects. RESULTS: Of the 63,526 patients recruited for the study, 1,081 (1.7%) (96.7% of whom were women, 54.2 [10.1] years old) met the criteria for FMS. After an adjustment for age and gender, FMS subjects used significantly more health care resources than the reference population and had more sick leave and the percentage of subjects with premature retirement was also significantly higher (P < 0.001 in all cases). As a result, FMS subjects showed an incremental adjusted per-patient per-year total cost of 5,010 euro (95% confidence interval [CI] 3,494 to 6,076, +153%, P < 0.001) on average compared with non-FMS subjects. Significantly higher differences were observed in both health care and non-health care adjusted costs: 614 euro (404 to 823, +66%) and 4,394 euro (3,373 to 5,420, +189%), respectively (P < 0.001 in both cases). Annual drug expenditure per patient on average was considerably higher in FMS patients, 230 euro (124 to 335, +64%, P < 0.001), than the reference group. CONCLUSIONS: Under routine medical practice, patients with FMS were associated with considerably higher annual total costs in the primary care setting compared with the reference population.

Metabolic syndrome in bipolar disorder: a cross-sectional assessment of a Health Management Organization database.

OBJECTIVE: To estimate the prevalence of metabolic syndrome (MS) in patients with bipolar disorder (BD) included in a Health Management Organization (HMO) database. METHODS: A cross-sectional analysis of the administrative claim database of Badalona Serveis Assistencials (BSA) was performed. All patients of either sex over 16 years of age and receiving treatment for BD for more than three weeks were included in the study group. The reference group comprised the rest of patients in the BSA database without BD. MS was defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III modified criteria and required fulfillment of at least three of the following five components: body mass index (BMI) >or=28.8 kg/m(2), triglycerides >or=150 mg/dL, high-density lipoprotein (HDL) cholesterol <40 mg/dL (males)/<50 mg/dL (females), blood pressure >or=130/85 mmHg, and fasting glucose >or=110 mg/dL. Descriptive statistics, bivariate analysis, and logistic regression models were applied. RESULTS: We identified 178 patients with BD out of 86,028 subjects (50.5% women; 45.5 +/- 17.8 years, mean +/- SD) included in the BSA database. MS prevalence was significantly higher in BD: 24.7% [95% confidence interval (CI): 18.6-31.7] versus 14.4% (CI: 14.2-14.7) with no statistically significant differences between genders; age-adjusted odds ratio (OR) = 1.65 (1.11-2.44, p = 0.013). All MS components were higher in the BD group, particularly BMI >28.8 kg/m(2) [33.1% (26.3-40.6) versus 17.9% (17.7-18.2), adjusted OR = 2.05 (1.46-2.87, p < 0.001)], high triglyceride levels [23.0% (17.1-29.9) versus 11.3% (11.1-11.5), adjusted OR = 2.09 (1.45-3.02, p < 0.001)], and low HDL cholesterol levels [54.5% (46.9-62.0) versus 29.4% (29.1-29.7), adjusted OR = 2.77 (2.02-3.80, p < 0.001)]. Furthermore, patients with BD showed a significantly higher frequency of obesity [41.4% (32.3-50.9) versus 27.1% (26.6-27.5); adjusted OR = 1.83 (1.24-2.68, p = 0.002)]. CONCLUSIONS: Compared with the general population managed by the BSA, the prevalence of MS was significantly higher in patients with BD, mainly due to a higher prevalence of obesity, high triglyceride levels, and low HDL cholesterol levels. These findings strongly support the development of health policies addressing this problem in BD patients.