A cost-effectiveness comparison of desipramine, gabapentin, and pregabalin for treating postherpetic neuralgia.
OBJECTIVE
To compare the net health effects and costs resulting from treatment with different first-line postherpetic neuralgia (PHN) medications.


METHODS
Cost-utility analysis using published literature.


METHODS
Hypothetical cohort of patients aged 60 to 80 with PHN.


METHODS
Desipramine 100 mg/d, gabapentin 1,800 mg/d, and pregabalin 450 mg/d.


METHODS
A decision model was designed to describe possible treatment outcomes, including different combinations of analgesia and side effects, during the first 3 months of therapy for moderate to severe PHN. The main outcome was cost per quality-adjusted life-year (QALY) gained. Costs were estimated using the perspective of a third-party payer. Multivariate, univariate, and probabilistic sensitivity analyses were performed, and the time frame of the model was varied to 1-month and 6-month horizons.


RESULTS
Desipramine was more effective and less expensive than gabapentin or pregabalin (dominant) under all conditions tested. Gabapentin was more effective than pregabalin but at an incremental cost of $216,000/QALY. Below $140/month, gabapentin became more cost-effective than pregabalin at a threshold of $50,000/QALY, and below $115/month gabapentin dominated pregabalin.


CONCLUSIONS
Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost-effective than pregabalin.
Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA. alec_oconnor@urmc.rochester.edu
Alec B
AB
O'Connor
Katia
K
Noyes
Robert G
RG
Holloway
D000368:Aged; D000588:Amines / Q000191:economics* / Q000627:therapeutic use*; D000700:Analgesics / Q000191:economics* / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003509:Cyclohexanecarboxylic Acids / Q000191:economics* / Q000627:therapeutic use*; D003891:Desipramine / Q000191:economics* / Q000627:therapeutic use*; D000077206:Gabapentin; D006801:Humans; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000188:drug therapy* / Q000191:economics*; D000069583:Pregabalin; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D000588:Amines; D000700:Analgesics; D000929:Antidepressive Agents, Tricyclic; D003509:Cyclohexanecarboxylic Acids; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003891:Desipramine