CHARACTERIZING THE PATIENTS WITH FIBROMYALGIA: A US REAL-WORLD CLAIMS ANALYSIS
Author(s)
Errol Gould, PhD;
Tonix Medicines, Inc., Chatham, NJ, USA
Tonix Medicines, Inc., Chatham, NJ, USA
OBJECTIVES: Fibromyalgia (FM) is a chronic pain condition. As per the National Fibromyalgia Association, it affects an estimated 10 million adults in the US. This study analyzed demographics, comorbidities, and healthcare resource utilization (HCRU) among US adults with FM using a large claims database.
METHODS: This retrospective cohort study utilized the Symphony closed claims database (04/2021-04/2024). Adult FM patients (≥18 years) were identified via ICD-10-CM code M79.7. Demographics, comorbidity, and HCRU patterns were assessed. Comorbidities were identified through ICD-10-CM diagnostic codes. Analysis focused on the third study year (2023-2024; Y3 cohort).
RESULTS: Year 3 cohort included 261,776 patients with median age 53 years (IQR: 43-61, range: 18-90, mean: 52.3±13.0). The majority was female (92.1%) and White non-Hispanic (49.6%). The payer mix was 35.2% Commercial, 13.0% Medicare Advantage, and 51.7% Medicaid. The largest patient cohort was 56-60 years old (15.5%), followed by 51-55 years old (15.2%) and 61-65 years old (13.6%). Comorbidity burden was substantial, with 93.2% having at least one FM-related comorbidity. The most prevalent comorbidities were anxiety/depression (63.9%), dorsalgia/back pain (56.5%), hypertensive diseases (51.4%), and joint pain (48.4%). Among patients covered under Commercial/Medicare Advantage with at least one non-zero claim (n=92,157), office visits showed the highest utilization (93.6%), followed by pharmacy services (61.3%). Inpatient costs represented the largest component of costs ($29,896), followed by pharmacy costs ($9,453) and outpatient costs ($6,196). Antidepressants (48.2%) were used most frequently, followed by NSAID analgesics (43.4%) and anticonvulsants (41.6%), with drug use patterns varying by race.
CONCLUSIONS: FM affects mostly female, middle-aged patients. They exhibit high comorbidity rates, including anxiety/depression and musculoskeletal conditions. HCRU is extensive, with most patients requiring office visits and pharmacy services, highlighting the need for comprehensive disease management and more effective therapeutic interventions to reduce the clinical and economic burden.
METHODS: This retrospective cohort study utilized the Symphony closed claims database (04/2021-04/2024). Adult FM patients (≥18 years) were identified via ICD-10-CM code M79.7. Demographics, comorbidity, and HCRU patterns were assessed. Comorbidities were identified through ICD-10-CM diagnostic codes. Analysis focused on the third study year (2023-2024; Y3 cohort).
RESULTS: Year 3 cohort included 261,776 patients with median age 53 years (IQR: 43-61, range: 18-90, mean: 52.3±13.0). The majority was female (92.1%) and White non-Hispanic (49.6%). The payer mix was 35.2% Commercial, 13.0% Medicare Advantage, and 51.7% Medicaid. The largest patient cohort was 56-60 years old (15.5%), followed by 51-55 years old (15.2%) and 61-65 years old (13.6%). Comorbidity burden was substantial, with 93.2% having at least one FM-related comorbidity. The most prevalent comorbidities were anxiety/depression (63.9%), dorsalgia/back pain (56.5%), hypertensive diseases (51.4%), and joint pain (48.4%). Among patients covered under Commercial/Medicare Advantage with at least one non-zero claim (n=92,157), office visits showed the highest utilization (93.6%), followed by pharmacy services (61.3%). Inpatient costs represented the largest component of costs ($29,896), followed by pharmacy costs ($9,453) and outpatient costs ($6,196). Antidepressants (48.2%) were used most frequently, followed by NSAID analgesics (43.4%) and anticonvulsants (41.6%), with drug use patterns varying by race.
CONCLUSIONS: FM affects mostly female, middle-aged patients. They exhibit high comorbidity rates, including anxiety/depression and musculoskeletal conditions. HCRU is extensive, with most patients requiring office visits and pharmacy services, highlighting the need for comprehensive disease management and more effective therapeutic interventions to reduce the clinical and economic burden.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD167
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)