title: Cost-effectiveness analysis of pharmacologic treatment of fibromyalgia in Mexico.
abstract: OBJECTIVE
  To identify, from the Mexican Public Health System perspective, which would be the most cost-effective treatment for patients with Fibromyalgia (FM).
  
  
  METHODS
  A Markov model including three health states, divided by pain intensity (absence or presence of mild, moderate or severe pain) and considering three-month cycles; costs and effectiveness were estimated for amitriptyline (50mg/day), fluoxetine (80 mg/day), duloxetine (120 mg/day), gabapentin (900 mg/day), pregabalin (450 mg/day), tramadol/acetaminophen (150 mg/1300 mg/día) and amitriptyline/fluoxetine (50mg/80 mg/día) for the treatment of FM. The clinical outcome considered was the annual rate of pain control. Probabilities assigned to the model were collected from published literature. Direct medical costs for FM treatment were retrieved from the 2006 data of the Mexican Institute of Social Security (IMSS) databases and were expressed in 2010 Mexican Pesos. Probabilistic Sensitivity Analyses were conducted.
  
  
  RESULTS
  The best pain control rate was obtained with pregabalin (44.8%), followed by gabapentin (38.1%) and duloxetine (34.2%). The lowest treatment costs was for amitriptyline ($ 9047.01), followed by fluoxetine ($ 10,183.89) and amitriptyline/fluoxetine ($ 10,866.01). By comparing pregabalin vs amitriptyline, additional annual cost per patient for pain control would be around $ 50.000 and $ 75.000 and would result cost-effective in 70% and 80% of all cases.
  
  
  CONCLUSIONS
  Among all treatment options for FM, pregabalin achieved the highest pain control and was cost-effective in 80% of patients of the Mexican Public Health System.
authors.affiliation: Programa Competitividad y Salud, Fundación Mexicana para la Salud, Colonia El Arenal, Tlalpan, México D.F. México.
authors.forename: Héctor
authors.initials: H
authors.lastname: Arreola Ornelas
authors.forename: Alfonso
authors.initials: A
authors.lastname: Rosado Buzzo
authors.forename: Lourdes
authors.initials: L
authors.lastname: García
authors.forename: Javier
authors.initials: J
authors.lastname: Dorantes Aguilar
authors.forename: Iris
authors.initials: I
authors.lastname: Contreras Hernández
authors.forename: Joaquín F
authors.initials: JF
authors.lastname: Mould Quevedo
mesh_terms: D000082:Acetaminophen / Q000191:economics / Q000627:therapeutic use; D000588:Amines / Q000191:economics / Q000627:therapeutic use; D000639:Amitriptyline / Q000191:economics / Q000627:therapeutic use; D000700:Analgesics / Q000191:economics* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003509:Cyclohexanecarboxylic Acids / Q000191:economics / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016527:Drug Costs; D004359:Drug Therapy, Combination; D000068736:Duloxetine Hydrochloride; D005356:Fibromyalgia / Q000188:drug therapy* / Q000191:economics; D005473:Fluoxetine / Q000191:economics / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D008390:Markov Chains; D008800:Mexico; D008954:Models, Biological; D018803:Models, Economic; D000069583:Pregabalin; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use; D014147:Tramadol / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000929:Antidepressive Agents, Tricyclic; D003509:Cyclohexanecarboxylic Acids; D013876:Thiophenes; D005473:Fluoxetine; D000639:Amitriptyline; D000082:Acetaminophen; D014147:Tramadol; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000068736:Duloxetine Hydrochloride