A cost-utility study of the use of pregabalin added to usual care in refractory neuropathic pain patients in a Swedish setting.
OBJECTIVE
Patients refractory to older therapies for neuropathic pain (NeP) have few remaining therapeutic options. This study evaluates the cost-utility of pregabalin in the treatment of patients with refractory neuropathic pain in Sweden, from a healthcare and a societal perspective.


CONCLUSIONS
The use of non-randomized (observational) data to determine the effectiveness of treatments for NeP. The use of non-Swedish data for some input parameters in the model.


METHODS
A previously constructed discrete event simulation model was adapted to compare pregabalin combined with usual care to usual care alone in a Swedish setting. Pain profiles were generated using clinical data from five non-randomized pregabalin studies in refractory NeP patients. Utility data were generated from a UK survey of patients with NeP. Cost data were generated from the Swedish Dental and Pharmaceutical Benefits Board (TLV's) product price database, a national NeP register, and a regional registry study. Indirect costs were estimated from published sources. One-way and probabilistic sensitivity analyses evaluated uncertainty in the model's output.


RESULTS
The incremental cost-effectiveness ratio (ICER) for pregabalin plus usual care treatment compared to usual care was 51,616 SEK/€5364 and 123,993 SEK/€12,886 with and without indirect costs, respectively. One-way sensitivity analyses confirmed the clinical input data as the main driver of the model; even considerable changes to all other input parameters had only a modest effect on the ICER. The ICER remained well below a conservative threshold of 347,495 SEK/€36,113/£30,000 in all scenarios modelled.


CONCLUSIONS
This study found pregabalin combined with usual care to be cost-effective compared to usual care in patients with refractory NeP from a Swedish Health Care perspective. Moreover, sensitivity analysis showed pregabalin's cost-effectiveness to be robust in all scenarios modelled.
Cardiff Research Consortium, Cardiff, Wales. matthew.prettyjohns@wales.nhs.uk
Matthew
M
Prettyjohns
Rebecka
R
Sandelin
Steven
S
Lister
Jan-Rickard
JR
Norrefalk
D000700:Analgesics / Q000191:economics* / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D017059:Models, Econometric; D009437:Neuralgia / Q000188:drug therapy* / Q000191:economics; D059408:Pain Management / Q000191:economics / Q000379:methods; D000069583:Pregabalin; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013548:Sweden; D013997:Time Factors; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D000700:Analgesics; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid