Cost effectiveness of duloxetine in the treatment of diabetic peripheral neuropathic pain in the UK.
OBJECTIVE
The objective of this analysis was to evaluate the cost-effectiveness of duloxetine when considered as an additional treatment option for UK-based patients suffering from diabetic peripheral neuropathic pain.


METHODS
A decision-analytic model was used to represent the sequential management of patients with diabetic peripheral neuropathic pain. The standard UK treatment strategy was defined as first-line tricyclic antidepressants (amitriptyline), second-line anticonvulsants (gabapentin) and lastly an opioid-related treatment. The cost-effectiveness of duloxetine was evaluated as an additional first, second, third or fourth-line therapy over a 6-month treatment period for a cohort of 1000 patients. Treatment response was modelled based on changes from baseline pain severity using a standard 11-point pain scale (0-10); full response (>or= 50% change), partial response (30-49%) and no response (< 30%). The model was populated with efficacy and discontinuation data using indirect comparisons of treatment efficacy based on relative effects to a common placebo comparator.


RESULTS
The second-line use of duloxetine resulted in cost savings of pound 77,071 for every 1000 treated patients, with an additional 29 patients achieving a full pain response when compared to standard UK treatment. Additional quality-adjusted life years (QALYs) were achieved at 1.88 QALYs per 1000 patients.


CONCLUSIONS
This UK-based economic model suggests that second-line use of duloxetine is a beneficial and cost-effective treatment strategy for diabetic peripheral neuropathic pain.
D000588:Amines / Q000627:therapeutic use; D000639:Amitriptyline / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D000068736:Duloxetine Hydrochloride; D000077206:Gabapentin; D006801:Humans; D017059:Models, Econometric; D017239:Paclitaxel / Q000627:therapeutic use; D010147:Pain Measurement; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D018434:Sickness Impact Profile; D013876:Thiophenes / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000928:Antidepressive Agents; D003509:Cyclohexanecarboxylic Acids; D013876:Thiophenes; D000639:Amitriptyline; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000068736:Duloxetine Hydrochloride; D017239:Paclitaxel