Cost-effectiveness analysis of pregabalin versus gabapentin in the management of neuropathic pain due to diabetic polyneuropathy or post-herpetic neuralgia.
OBJECTIVE
To estimate the cost-effectiveness of branded pregabalin (PGB) versus generic gabapentin (GBP) in patients with neuropathic pain (NeP) due to painful diabetic polyneuropathy (DPN) or post-herpetic neuralgia (PHN) in Spain.


METHODS
Using stochastic simulation, we estimated the cost-effectiveness of PGB 150-600 mg/d vs. GBP 900-3600 mg/d in a hypothetical cohort of 1000 patients. The model used data from three randomized controlled clinical trials. Pain was evaluated using a 0-10 scale. Mean baseline pain was 6.9 in both treatment groups. The model assigned untreated pain scores over 84 days. Treated scores were calculated using weekly changes in pain scores from trials. Outcomes included the numbers of days with no or mild pain (score < 4), days with >or= 30% and >or= 50% reductions in pain intensity, quality-adjusted life-years (QALYs), and estimated health costs.


RESULTS
Compared with GBP, PGB yielded an estimated mean of 8 (standard error, 0.4) additional days with no or mild pain, 6 (0.4) days with >or= 30% reduction in pain intensity, 9 (0.5) days with >or= 50% reduction in pain intensity, and a gain of 0.1186 (0.0002) QALYs for 12 weeks. The estimated total health costs of therapies were euro 1049 (euro 35) for PGB and euro 951 (euro 38) for GBP, respectively. Incremental cost-effectiveness ratio (ICER) for PGB versus GBP were a mean of euro 12 (95% confidence interval, euro 1-24) per additional day with no or mild pain, euro 431 (dominant-euro 876) per additional patient with no or mild pain, and euro 20 535 (euro 1607-40 345) per QALY gained.


CONCLUSIONS
According with data used in this modeling in patients with NeP due to DPN and/or PHN, PGB was shown to be more cost-effective than generic gabapentin in Spain.
Rodríguez
M J
MJ
Pain and Palliative Care Unit, Carlos Haya University Hospital, Málaga, Spain. maje1946@yahoo.es
Díaz
S
S
Vera-Llonch
M
M
Dukes
E
E
Rejas
J
J
D000588:Amines / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003509:Cyclohexanecarboxylic Acids / Q000191:economics* / Q000627:therapeutic use*; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D004311:Double-Blind Method; D000077206:Gabapentin; D006562:Herpes Zoster / Q000188:drug therapy*; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010919:Placebos; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D010919:Placebos; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin