THU0511 Estimating the Burden of Illness of Fibromyalgia in Taiwan
Authors: B. C. M. Wang, W. E. Furnback, J. P. Ney, L. P. Garrison, C. Fang
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Fibromyalgia is a disorder often characterized by chronic musculoskeletal pain over multiple regions of the body not explained by anatomical injury <sup>[1]</sup>. There are limited treatments for fibromyalgia. <h3>Objectives</h3> To determine and characterize the potential total direct and indirect costs associated with fibromyalgia in Taiwan. <h3>Methods</h3> We utilized a micro-costing approach to estimating direct and indirect costs in a burden-of-illness model <sup>[2]</sup>. Direct healthcare costs were for primary treatment drugs, drugs for comorbidities, hospitalization utilization, tests, and outpatient visits. Indirect costs were projected due to both presenteeism (decreased productivity) and absenteeism (missing work). Direct cost data came from publically-available sources, while indirect costs were based on a human capital approach using per capita income levels. Estimates of quantities and frequencies of the components in the burden of illness calculations came from local physician questionnaires and an advisory board with national experts (rheumatologist, pain specialists, and neurologist). We reported costs over one, five, and ten-year horizons using a 3% discount rate. Additionally, costs were also compared to gross domestic product (GDP) and total healthcare expenditure, which is 6.5% of GDP <sup>[3,4]</sup>. Projections for prevalence trends were based on the expert judgment of the advisory board. Costs were reported in 2013 USD. <h3>Results</h3> From our questionnaires, we estimated that fibromyalgia affects 1.5% of the population—an estimated 407,000 people in Taiwan. It was associated with a total economic burden of illness of $2.3 billion in 2012 ($1.5 billion and $0.8 billion from indirect and direct costs, respectively). The bulk of direct healthcare costs were from primary treatment drugs ($440 million) followed by drugs for comorbidities ($226 million), outpatient visits ($59 million), hospitalization utilization ($29 million), and tests ($21 million). For indirect costs, $1.2 billion was associated with presenteeism via decreased productivity, and $255 million was associated with absenteeism. The direct costs of fibromyalgia are projected to account for 2.5% of Taiwan's annual healthcare expenditure, and the total costs would account for 0.5% of total domestic output. The annual costs per capita and per fibromyalgia patient are $99 and $5,600, respectively. Our model forecasts five and ten-year aggregate costs to be $10.9 billion and $20.4 billion, respectively. <h3>Conclusions</h3> In Taiwan, the aggregate burden of illness for fibromyalgia is estimated to be over $2 billion annually. The bulk of the costs are associated with presenteeism and absenteeism, likely due to chronic pain and fatigue experienced by fibromyalgia sufferers. New treatments for the disease may reduce its burden on society. <h3>References</h3> Wolfe F et al. The american college of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. ACR 2010;62:600-610. Fishman P, Hornbrook M. Assigning resources to health care use for health services rsearch: options and consequences. <i>Medical Care</i> 2009;47(7): S70-S75. "CIA World Factbook, Taiwan." CIA, n.d. Web. 17 Jan. 2013. Checking up on Taiwan healthcare: Market challenges and opportunities. Retrieved from: http://www.pwc.tw/en_TW/tw/industries/publications/assets/healthcare-en.pdf[09/01/13]. <h3>Acknowledgements</h3> Taiwan Fibromyalgia Outcomes Research Meeting Group (in alphabetical order): Der-Yuan Chen (Taichung Veterans General Hospital, Taichung, Taiwan); Jiunn-Horng Chen (China Medical University Hospital, Taichung, Taiwan); Chih-Jen Hung (Taichung Veterans General Hospital, Taichung, Taiwan); Wei-Zen Sun (National Taiwan University Hospital, Taipei, Taiwan); Yu-Chuan Tsai (National Cheng Kung University Hospital, Tainan, Taiwan); Shuu-Jiun Wang (Taipei Veterans General Hospital, Taipei, Taiwan); Shey-Lin Wu (Yumin Hospital, Changhua, Taiwan); Chih-Chao Yang (National Taiwan University Hospital, Taipei, Taiwan); Kuang-Hui Yu (Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan). <h3>Disclosure of Interest</h3> B. Wang Grant/research support from: Pfizer Taiwan, W. Furnback Grant/research support from: Pfizer Taiwan, J. Ney Grant/research support from: Pfizer Taiwan, L. Garrison Grant/research support from: Pfizer Taiwan, C. Fang Grant/research support from: Pfizer Taiwan