title: Evaluation of healthcare resource utilization and costs in employees with pain associated with diabetic peripheral neuropathy treated with pregabalin or duloxetine.
abstract: OBJECTIVE
  To evaluate changes in healthcare resource use and costs after initiating pregabalin or duloxetine in employees with pain associated with diabetic peripheral neuropathy (pDPN).
  
  
  METHODS
  Employees (18-64 years old) with a DPN diagnosis and at least one pDPN-related pain medication claim were identified using the MarketScan Commercial Database (2005-2008). Propensity scored matched pregabalin and duloxetine new starts were evaluated in the 6-month pre- and 6-month post-initiation periods. Study outcomes including imputed medically-related work loss, prescription and healthcare utilization, and associated expenditures were analyzed using univariate statistics and multivariate models in a difference-in-difference approach.
  
  
  RESULTS
  A total of 473 employees in each treatment group were identified. Mean age was 53.6 (SD 7.0) years for pregabalin and 53.5 (SD 7.4) years for duloxetine. There were no pre-index differences between groups. Adjusted marginal effects were not statistically significant for pre-to-post changes in opioid utilization (p = 0.328), number of pDPN-related analgesic medications (p = 0.506), all-cause healthcare costs (p = 0.895), indirect costs (p = 0.324), or pDPN-attributable expenditures (p = 0.359).
  
  
  CONCLUSIONS
  Claims analysis is limited in accounting for all patient and plan differences, and by the reliability of medical claims for diagnosis coding. The sample size of the matched cohorts may have limited the power of the analysis to detect differences.
  
  
  CONCLUSIONS
  There were no significant pre-to-post differences between pregabalin and duloxetine treatment groups in pDPN-related analgesic medication use, or pDPN-attributable, all-cause, and indirect expenditures.
authors.affiliation: Thomson Reuters, Healthcare & Science, Washington, DC 19004, USA. jay.margolis@thomsonreuters.com
authors.forename: Jay
authors.initials: J
authors.lastname: Margolis
authors.forename: Zhun
authors.initials: Z
authors.lastname: Cao
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.forename: James
authors.initials: J
authors.lastname: Harnett
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sanchez
authors.forename: Jack
authors.initials: J
authors.lastname: Mardekian
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000700:Analgesics / Q000191:economics* / Q000627:therapeutic use; D015897:Comorbidity; D003929:Diabetic Neuropathies / Q000150:complications; D000068736:Duloxetine Hydrochloride; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D000069583:Pregabalin; D012737:Sex Factors; D012959:Socioeconomic Factors; D013876:Thiophenes / Q000191:economics* / Q000627:therapeutic use; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000068736:Duloxetine Hydrochloride