Patterns of health care utilization related to initiation of amitriptyline, duloxetine, gabapentin, or pregabalin in fibromyalgia
Patterns of health care utilization related to initiation of amitriptyline, duloxetine, gabapentin, or pregabalin in fibromyalgia
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DOI：
10.1186/s13075-015-0530-8
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发表时间：
2015-01-28
影响因子：
4.9
通讯作者：
Lee, Yvonne C.
中科院分区：
文献类型：
--
作者：
Kim, Seoyoung C.;Landon, Joan E.;Lee, Yvonne C.
简介：几种药物治疗可用于纤维肌痛，但鲜为人知的是，这些治疗对医疗保健utilization.Methods的比较有效性：使用美国商业保险索赔数据（涵盖2007年至2009年），我们进行了一项队列研究，以检查阿米替林，度洛沙汀，加巴喷丁，普瑞巴林对纤维肌痛患者的医疗保健利用的比较有效性。我们测量了患者的用药依从性使用覆盖天数比例（PDC）和估计的多变量率比（RR）的门诊，处方，住院，急诊（艾德）访问倾向评分（PS）匹配cohols.Results：队列的8,269阿米替林，9,941度洛昔单抗，18,613加巴喷丁启动者进行了比较，他们的PS匹配普瑞巴林启动。在基线180天期间，患者平均有7至9次医生就诊，包括6至8次专家就诊，并接受8种处方药。180天的平均PDC从38.6%到67.7%不等。开始使用一种研究药物后，门诊访视、处方和住院的次数略有减少，但治疗开始后艾德访视的次数增加。与普瑞巴林相比，度洛沙汀与门诊就诊次数减少相关（RR，0.94; 95%置信区间（CI），0.88 - 1.00），处方（RR，0.94; 95% CI，0.90 - 0.98）、住院（RR，0.75; 95% CI，0.68 - 0.83）和艾德访视（RR，0.85; 95% CI，0.79 - 0.91）。阿米替林和加巴喷丁发起人之间的医疗保健利用率的差异不大，注意到那些谁开始对pregabalin.Conclusions：纤维肌痛患者有较高的医疗保健利用率之前和之后开始阿米替林，度洛沙汀，加巴喷丁，或普瑞巴林。药物依从性欠佳。总体而言，纤维肌痛治疗对降低医疗保健利用率的影响很小，但度洛沙坦启动者的医疗保健利用率低于普瑞巴林启动者。
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.