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Factors associated with healthcare costs in women with fibromyalgia.

OBJECTIVE
To examine how women with high and low healthcare costs differ by using the Anderson Health Behavior Model of Utilization as a theoretical framework.


STUDY DESIGN
One-year longitudinal design.


PATIENTS AND METHODS
A total of 537 female health maintenance organization members with fibromyalgia participating in a study examining the effects of social support and education on health status and healthcare use were divided into 2 groups using a median split on health costs. Predisposing variables (demographic variables, self-efficacy, depression, and social support), enabling characteristics (income), and need variables (health status, perceived health status, disease severity, duration of symptoms, and comorbidity) were measured. Patients completed a battery of questionnaires at baseline assessment, and healthcare costs were assessed 1 year before and 1 year after baseline assessment. Healthcare data were collected from medical records. Healthcare costs were estimated by multiplying the number of each type of healthcare contact by the most recent national average cost figures.


RESULTS
Multivariate analysis of covariance controlling for costs during the year before baseline assessment was performed. Low-cost patients had fewer comorbid conditions, better health status, higher self-perceived health status, less disease severity, greater self-efficacy for functioning, lower depression scores, and higher social support scores. Chi2 analyses revealed no significant differences between groups on marital status but a significant difference in income: low-cost patients were more likely to report higher incomes.


CONCLUSIONS
There were several significant differences between people with higher and lower healthcare costs. Although effect sizes were small, many variables may be responsive to intervention.