title: Economic evaluation of duloxetine as a first-line treatment for painful diabetic peripheral neuropathy in Mexico.
abstract: OBJECTIVE
  To perform an economic evaluation of duloxetine, pregabalin, and both branded and generic gabapentin for managing pain in patients with painful diabetic peripheral neuropathy (PDPN) in Mexico.
  
  
  METHODS
  The analysis was conducted using a 3-month decision model, which compares duloxetine 60 mg once daily (DUL), pregabalin 150 mg twice daily (PGB), and gabapentin 600 mg three-times daily (GBP) for PDPN patients with moderate-to-severe pain. A systematic review was performed and placebo-adjusted risk ratios for achieving good pain relief (GPR), adverse events (AE), and withdrawal owing to intolerable AE were calculated. Direct medical costs included drug acquisition and additional visits due to lack of efficacy (poor pain relief) or intolerable AE. Unit costs were taken from local sources. Adherence rates were used to estimate the expected drug costs. All costs are expressed in 2010 Mexican Pesos (MXN). Utility values drawn from published literature were applied to health states. The proportion of patients with GPR and quality-adjusted life years (QALY) were assessed.
  
  
  RESULTS
  Branded-GBP was dominated by all the other options. PGB was more costly and less effective than DUL. Compared with branded-GBP and PGB, DUL led to savings of 1.01 and 1.74 million MXN (per 1000 patients). The incremental cost per QALY gained with DUL used instead of generic-GBP was $102 433 MXN. This amount is slightly lower than the estimated gross domestic product per capita in Mexico for 2010. During a second-order Monte Carlo simulation, DUL had the highest probability of being cost-effective (61%), followed by generic-GBP (25%) and PGB (14%).
  
  
  CONCLUSIONS
  Study limitations include a short timeframe and using data from different dosage schemes for GBP and PGB.
  
  
  CONCLUSIONS
  This study suggests that DUL provides overall savings and better health outcomes compared with branded-GBP and PGB. Administering DUL rather than generic-GBP is a cost-effective intervention to manage PDPN in Mexico.
authors.affiliation: R A C Salud Consultores, S.A. de C.V. , Ciudad de México , México. fernando.carlos@racsalud.com
authors.forename: Fernando
authors.initials: F
authors.lastname: Carlos
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Ramírez-Gámez
authors.forename: Héctor
authors.initials: H
authors.lastname: Dueñas
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Galindo-Suárez
authors.forename: Elisa
authors.initials: E
authors.lastname: Ramos
mesh_terms: D000588:Amines / Q000191:economics; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003509:Cyclohexanecarboxylic Acids / Q000191:economics; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D016527:Drug Costs; D000068736:Duloxetine Hydrochloride; D000077206:Gabapentin; D006801:Humans; D008800:Mexico; D000069583:Pregabalin; D013876:Thiophenes / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000191:economics
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D018765:Dopamine Uptake Inhibitors; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000068736:Duloxetine Hydrochloride