title: Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with diabetic neuropathy newly prescribed pregabalin or gabapentin.
abstract: OBJECTIVE
  To characterize comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with painful diabetic peripheral neuropathy (pDPN) newly prescribed pregabalin or gabapentin in clinical practice.
  
  
  METHODS
  Using the LifeLink(™) Health Plan Claims Database, patients with pDPN (ICD-9-CM codes 357.2 or 250.6) newly prescribed (index event) gabapentin (n = 1,178; 56.9 ± 10.3 years old) were identified and propensity score-matched with patients initiated on pregabalin (n = 1,178; 56.4 ± 9.8 years old). Comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods.
  
  
  RESULTS
  Both cohorts were characterized by multiple comorbidities and substantial use of pain-related and adjunctive medications. In the pregabalin cohort, the use of tricyclic antidepressants significantly decreased (16.0% vs. 13.2%) and nonsteroidal anti-inflammatory drugs (30.8% vs. 34.8%), muscle relaxants (19.2% vs. 22.9%), anticonvulsants (14.4% vs. 18.1%), benzodiazepines (22.3% vs. 25.0%), and topical agents (7.0% vs. 9.8%) increased (P < 0.05) in the follow-up period. In the gabapentin cohort, there were significant increases (P < 0.05) in the use of short-acting (55.4% vs. 61.2%) and long-acting (9.4% to 12.8%) opioids, serotonin-norepinephrine re-uptake inhibitors (14.2% vs. 16.7%), anticonvulsants (7.1% vs. 19.2%), benzodiazepines (19.1% vs. 24.3%), sedative/hypnotics (14.9% vs. 18.0%), and tramadol (13.3% vs. 16.8%). There were significant increases (P < 0.05) in pharmacy, outpatient, and total costs in both cohorts and in costs of physician office visits in the gabapentin cohort. There was no difference in postindex median total costs between the pregabalin and gabapentin cohorts ($16,137 vs. $15,766).
  
  
  CONCLUSIONS
  Patients with pDPN prescribed pregabalin and gabapentin had a substantial comorbidity and pain medication burden. Although healthcare costs increased in both groups, the increase in pain medication burden was higher in the gabapentin group. Direct medical costs were similar for both groups. Given the human and economic burden of pDPN, future research may benefit from a focus on efficacy parameters to further differentiate treatment options.
authors: Avalon Health Solutions, Inc., Philadelphia, Pennsylvania 19102, USA. mgore@avalonhealthsolutions
authors: Mugdha
authors: M
authors: Gore
authors: Kei-Sing
authors: KS
authors: Tai
authors: Gergana
authors: G
authors: Zlateva
authors: Arthi
authors: A
authors: Bala Chandran
authors: Douglas
authors: D
authors: Leslie
mesh_terms: D000368:Aged; D000588:Amines / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use*; D000704:Analysis of Variance; D015331:Cohort Studies; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D005260:Female; D000077206:Gabapentin; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D000069583:Pregabalin; D055553:Prescription Drugs / Q000191:economics / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D055553:Prescription Drugs; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin