A cost-utility analysis of pregabalin in the management of peripheral neuropathic pain.
OBJECTIVE
To assess the cost per QALY (quality-adjusted life years) of pregabalin in the management of peripheral neuropathic pain.


METHODS
We compared pregabalin on top of "usual care" with "usual care" alone. In this study, usual care was defined as a mix of drug therapies, excluding anti-epileptic drugs (AEDs), because the latter represented only 9% of current use, and clinical evidence of pregabalin was demonstrated versus usual care without anti-epileptic drugs. A Markov model was developed to simulate the evolution of a patient cohort over 1 year, and applied cycles of 4 weeks. During each cycle, patients remained in 1 out of 4 possible states: severe, moderate or mild pain, and therapy withdrawal. The health care payers perspective was taken into account. Clinical data were obtained from a trial comparing usual care plus placebo to usual care plus pregabalin, at either 150, 300, or 300/600 mg/day (the latter depending on clearance of creatinin). Resulting effects on pain were transformed into transition-probabilities between different pain levels. Cost and SF36 utility data of pain levels were obtained from a 1-month observational study in 88 patients.


RESULTS
Usual care resulted in a yearly cost of Euros 6,200 compared to Euros 5,984 for an all dose pregabalin-mix, meaning a cost saving of Euros 216 per patient. Utility increase was 0.01 for the pregabalin-mix (QALY 0.510 usual care; 0.520 pregabalin-mix). Monte Carlo analysis showed cost savings were not significant. However, the utility gain, albeit small, was statistically significant.


CONCLUSIONS
Based on this analysis, it may be concluded, that in the considered patient population, at the specialist level, pregabalin is at least cost neutral to current usual care (without AEDs) and offers a slight but significant increase in quality of life.
Annemans
L
L
IMS Health, De Crayerstraat 6, 1000 Brussel, Belgium. lieven.annemans@ugent.be
Caekelbergh
K
K
Morlion
B
B
Hans
G
G
De Cock
P
P
Marbaix
S
S
D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000150:complications* / Q000188:drug therapy / Q000191:economics; D000069583:Pregabalin; D012189:Retrospective Studies; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D000700:Analgesics; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid