• Yang Zhao, Shih-Yin Chen, Ning Wu, Kimberly A Fraser, and Luke Boulanger.
• Global Health Outcomes, Eli Lilly and Company, Indianapolis, Indiana 46221, USA. zhao_yang_yz@lilly.com
• Pain Pract. 2011 Jul 1;11(4):381-91.

ObjectiveThe study aims to examine predictors associated with duloxetine adherence and its association with healthcare costs among fibromyalgia patients.MethodsAdministrative claims from both commercially and Medicare supplemental-insured fibromyalgia patents aged 18+ who initiated duloxetine in 2006 were analyzed. Initiation was defined as a 90-day clean period without duloxetine. The dispense date of the first duloxetine prescription was denoted as the index date. Two cohorts were constructed based on duloxetine adherence over the 12-month postindex period (high adherence as medication possession ratio ≥0.8). Predictors of high adherence were examined via logistic regression. Generalized linear regressions were performed to estimate the association between duloxetine adherence and healthcare costs.ResultsA total of 4,869 commercially and 566 Medicare supplemental-insured fibromyalgia patients were identified. Two-thirds of patients had low adherence. Higher duloxetine average daily dose (ADD) was associated with increased adherence (reference group=30mg; Commercial: Odds ratio [OR]=3.03, 2.40, and 3.73 for 31 to 59mg, 60mg, and >60mg, respectively, all P<0.05; Medicare supplemental: OR=3.11, 2.33, and 4.76 for 31 to 59mg, 60mg, and >60mg, respectively, all P<0.05). Commercially insured patients with high adherence had significantly lower total healthcare costs than low-adherence patients (-$1,164, P<0.05), primarily because of lower inpatient (-$2,222, P<0.05) and outpatient (-$1,075, P<0.05) costs. Medicare supplemental-insured patients with high adherence had similar overall and inpatient costs, but significantly lower outpatient costs (-$2,025, P<0.05).ConclusionFibromyalgia patients with higher duloxetine ADD were more likely to adhere to the therapy. High duloxetine adherence was associated with lower (Commercial) or similar (Medicare supplemental) healthcare costs.© 2010 Eli Lilly and Company. Pain Practice © 2010 World Institute of Pain.

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