Patients with FM in China incur significant direct costs as a result of their condition. Per patient direct costs of ¥17,377 were driven by FM medication and healthcare resource utilization. To the authors' knowledge, this is the first estimation of the economic burden of FM patients in China.
Globally the economic impact of fibromyalgia has been extensively reported. While the difference in health systems and costs makes a direct comparison between the results from this analysis to analyses in other health settings difficult, the drivers of costs can be compared. The exact prevalence and incidence of FM in China are largely unknown. There have been few studies attempting to estimate the prevalence in different regions and cities, and no studies estimating nationally [4–5]. A 2015 study evaluating the prevalence of FM in a small sample of 4,056 residents of Shantou estimated a prevalence rate of 0.12% . A similar study conducted in Hong Kong reported a prevalence of 0.82% .
In Taiwan, the direct cost per year for patients with FM was estimated to be ¥14,000. FM-related medications were responsible for 56.6% (¥7585) of costs, resource utilization was 14.1% (¥1885), and comorbid medication was due to 29.2% of costs  A study of Japanese patients with FM determined the per-patient direct costs were ¥126,500, which were significantly higher than a matched cohort of non-FM patients .
The average annual direct cost per FM patient in the United States with a diagnosis of FM diagnosis during the period of 2001–2004 was ¥77,000. Direct costs were driven by outpatient pharmaceuticals (28.8%), inpatient stays (14.8%), and physician visits (7.6%) . A study in the United States compared the costs and healthcare resource utilization of patients with FM based on severity. Of all the direct costs to the payer, 76.2% were for prescription medications in mild patients compared to 62.1% and 62.2% in moderate and severe patients, respectively .
Other economic burden studies have been conducted in China for other chronic disease areas. A 2019 publication estimated the economic burden of postherpetic neuralgia in China using a similar method. The study found total direct medical costs of ¥10,600. The costs were driven by higher hospitalization costs of ¥9300 compared to our study, which was driven mostly by higher drug costs . The societal costs of patients with rheumatoid arthritis across 21 tertiary care hospitals between July 2009 and December 2010 were studied . The total societal cost per patient-year was estimated to be ¥27,000, of which 90% (¥24,300) were direct costs. The primary driver (> 50%) of costs were drug costs, which was similar to our analysis . Patients with diabetes were reported to have total annual medical costs of ¥19,600 and diabetes-related costs of ¥13,100, which was closely correlated with our estimated annual direct cost of ¥17,377 for FM patients .
The results of this analysis can be used by stakeholders in China to better understand the different sources of costs for FM patients in the healthcare system. While FM-related medications were the largest contributor to direct medical costs, the cost of treating comorbid conditions represented a significant 10.7% of direct medical costs. The optimal treatment selection to effectively treat FM and control comorbid conditions such as depression, anxiety, and sleep disturbance, could result in a reduction in treatment costs and healthcare resource utilization. Lastly, physician education is an important component of the effectiveness of treating FM. Physicians understanding the nature of the disease are able to more effectively treat it through the selection of the correct medication(s) for each individual patient and thus improve patient outcomes and perhaps lower the indirect costs associated with FM. Furthermore, treatments could include exercise and other healthy habits with minimal cost on the payer system.
This study has several limitations. First, the model included an average patient and the treatment patterns were heavily influenced by the physician survey. Within China, access to certain medications and the prices of medications can vary significantly, which would influence the cost of care. Second, this study may underestimate the economic burden of FM as it did not consider medications outside of FM medications and the three included comorbidities. There may be additional medications utilized by FM patients that were not covered. Additionally, the study only considered the costs of healthcare resource utilization for physician visits, lab tests, radiologic tests, and hospitalizations. FM patients likely utilize other healthcare services FM-related events. Third, the model did not consider the humanistic burden associated with FM, which is significant. Fourth, we did not include indirect costs in the study due to lack of data and reliable sources. Lastly, the model relied on data reported in the physician survey, which was made up of physicians with a relatively high caseload of FM patients. These results were based on physician impressions and not chart reviews, so one cannot determine whether the patients fulfilled any specific criteria for FM. Patients under the care of physicians without as much knowledge of FM may experience a different level of care. Moreover, there are limitations to generalizing the results of a survey based on 6 physicians to an entire country, such as China. The physicians do not represent the wide-ranging geographic regions of the country.