SAT0398 Diagnosis of Fibromyalgia is Associated with Impaired Health Outcomes and Substantial Health Care Costs After Nine Months of Follow-Up
Authors: M. Kroese, R. Landewé, G. Schulpen, J. Severens
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Little is known about the impact and prognosis after establishing a diagnosis of fibromyalgia (FM). It is possible that acquiring a 'FM-label' may lead to increased illness behaviour, dependence on health care providers, and increased health care costs. On the other hand, a timely and definite diagnosis may lead to a better health related quality of life (HRQoL) and a reduction of health care costs. The fact that timing in diagnosis could be important was one of the reasons for conducting a randomized controlled trial (RCT) on referred patients with symptoms suggestive of FM, in which diagnostic visits performed by a specialized rheumatology nurse (SRN) within 3 weeks ('early diagnosis') after referral were compared with diagnostic visits performed by a rheumatologist (RMT) after a regular waiting period of approximately 3 months ('regular diagnosis')<sup>1</sup>. <h3>Objectives</h3> To compare in a post-hoc analysis the 9 months prognosis of patients in whom a FM diagnosis was made with patients in whom another diagnosis was made (non-FM) with respect to health outcomes and health care costs and to investigate the effects of an 'early' versus a ('regular' diagnosis. <h3>Methods</h3> All patients were participants in a RCT (n=193) on the feasibility of a nurse-led diagnostic process in making a FM diagnosis, and were referred to the rheumatology outpatient clinic with FM symptoms<sup>1</sup>. They were allocated to an 'early' diagnosis group, and seen by a supervised SRN within 3 weeks or to a ('regular' diagnosis group, and seen by a RMT within 3 months. Health outcomes, measured at baseline and after 9 months follow-up, were e.g. HRQoL and functional status. Costs were measured by 2-monthly questionnaires on medical consumption and productivity. <h3>Results</h3> Of all patients, 82.4% (n=159) met the American College of Rheumatology criteria for FM and in 33 patients (17.1%) another diagnosis was made. FM patients had a longer duration of complaints (6.3 yrs vs. 4.2 yrs; <i>P</i>=0.029) and indicated more additional health problems (85.5% vs. 66.7%; <i>P</i>=0.01) than non-FM patients. Before the diagnosis was made, FM patients scored consistently worse than non-FM patients. Timing of diagnosis (early vs. regular) did not influence these results. During 9 months follow-up, FM patients showed a stable course in almost all health outcomes, while non-FM patients improved in these outcomes. FM patients created slightly more healthcare costs than non-FM patients (€1498 vs. €1315; Δ €-183, 95% CI €-613 to €255), but costs related to absenteeism from work were slightly higher in non-FM patients (€3031 vs. €3732; Δ €701, 95% CI €-2474 to €5226). An early diagnosis, however, importantly saved both health care and societal costs in non-FM patients (total societal costs early vs. regular diagnosis: €700 vs. €6425; Δ €5725, 95% CI €1985 to €10.988). <h3>Conclusions</h3> Patients who got a FM diagnosis had far worse health outcomes at baseline and after 9 months follow-up than non-FM patients. For FM patients, timing of the diagnosis appeared little important. <h3>References</h3> Kroese M, Schulpen G, Bessems M, Severens J, Nijhuis F, Geusens P, et al. Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: a randomized controlled trial. Arthritis Care Res 2008;59:1299-1305. <h3>Disclosure of Interest</h3> None Declared