title: A cost-utility analysis of pregabalin versus duloxetine for the treatment of painful diabetic neuropathy.
abstract: The objective of the current study was to determine the cost-utility of pregabalin versus duloxetine for treating painful diabetic neuropathy (PDN) using a decision tree analysis. Literature searches identified clinical trials and real-world studies reporting the efficacy, tolerability, safety, adherence, opioid usage, health care utilization, and costs of pregabalin and duloxetine. The proportions of patients reported in the included studies were used to determine probabilities in the decision tree model. The base-case model included the Food and Drug Administration (FDA)-approved doses of pregabalin (300 mg/day) and duloxetine (60 mg/day), whereas "real-world" sensitivity analyses explored the effects over a range of doses (pregabalin 75-600 mg/day, duloxetine 20-120 mg/day). A 6-month time horizon and a US third-party payer perspective were chosen for the study. Outcomes from the model were expressed as cost per quality-adjusted life-year (QALY). In the base-case model, duloxetine cost less and was more effective than pregabalin (incremental cost -$187, incremental effectiveness 0.011 QALYs). Results from two real-world sensitivity analyses indicated that duloxetine cost $16,300 and $20,667 more per additional QALY than pregabalin. Using a decision tree model that incorporated both clinical trial and real-world data, duloxetine was a more cost-effective option than pregabalin in the treatment of PDN from the perspective of third-party payers.
authors.affiliation: Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, Utah 84108, USA. brandon.bellows@pharm.utah.edu
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Bellows
authors.forename: Arati
authors.initials: A
authors.lastname: Dahal
authors.forename: Tianze
authors.initials: T
authors.lastname: Jiao
authors.forename: Joseph
authors.initials: J
authors.lastname: Biskupiak
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000191:economics; D004305:Dose-Response Relationship, Drug; D017277:Drug Approval; D000068736:Duloxetine Hydrochloride; D006801:Humans; D018803:Models, Economic; D000069583:Pregabalin; D019057:Quality-Adjusted Life Years; D013876:Thiophenes / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D014481:United States; D014486:United States Food and Drug Administration; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D000928:Antidepressive Agents; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000068736:Duloxetine Hydrochloride