title: Duloxetine for the treatment of painful diabetic peripheral neuropathy in Venezuela: economic evaluation.
abstract: BACKGROUND
  Painful diabetic peripheral neuropathy affects 40-50% of patients with diabetic neuropathy, leading to impaired quality of life and substantial costs. Duloxetine and pregabalin have evidence-based support, and are formally approved for controlling painful diabetic peripheral neuropathy.
  
  
  METHODS
  We used a 12-week decision model for examining painful diabetic peripheral neuropathy first-line therapy with daily doses of duloxetine 60mg or pregabalin 300mg, under the perspective of the Instituto Venezolano de los Seguros Sociales. We gathered model parameters from published literature and expert´s opinion, focusing on the magnitude of pain relief, the presence of adverse events, the possibility of withdrawal owing to intolerable adverse events or due to lack of efficacy, and the quality-adjusted life years expected in each strategy. We analyzed direct medical costs (which are expressed in Bolívares Fuertes, BsF) comprising drug acquisition besides additional care devoted to treatment of adverse events and poor pain relief. We conducted both deterministic and probabilistic sensitivity analyses.
  
  
  RESULTS
  Total expected costs per 1000 patients were BsF 1 046 146 (26%) lower with duloxetine than with pregabalin. Most of these savings (91%) corresponds to the difference in the acquisitions cost of each medication. duloxetine also provided 23 more patients achieving good pain relief and a gain of about two quality-adjusted life years per 1000 treated. Model was robust to plausible changes in main parameters. Duloxetine remained the preferred option in 93.9% of the second-order Monte Carlo simulations.
  
  
  CONCLUSIONS
  This study suggests duloxetine dominates (i.e., is more effective and lead to gains in quality-adjusted life years), remaining less costly than pregabalin for treatment of painful diabetic peripheral neuropathy.
authors.affiliation: R A C Salud Consultores, S.A. de C.V. Address: Insurgentes Sur 598 P2-204 Mza. Col. Del Valle, Deleg. Benito Juárez, Ciudad de México, D.F. México, C.P. 03100. Email: fernando.carlos@racsalud.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Carlos
authors.affiliation: Consultor independiente.
authors.forename: Luis
authors.initials: L
authors.lastname: Espejel
authors.affiliation: Eli Lilly and Company, Windlesham, Surrey, UK.
authors.forename: Diego
authors.initials: D
authors.lastname: Novick
authors.affiliation: Eli Lilly and Company, Caracas, Venezuela.
authors.forename: Rubén
authors.initials: R
authors.lastname: López
authors.affiliation: Eli Lilly and Company, Buenos Aires, Argentina.
authors.forename: Daniel
authors.initials: D
authors.lastname: Flores
mesh_terms: D000700:Analgesics / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000191:economics; D000068736:Duloxetine Hydrochloride / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D000069583:Pregabalin / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014687:Venezuela
chemical_list: D000700:Analgesics; D000069583:Pregabalin; D000068736:Duloxetine Hydrochloride
keywords: Venezuela; cost-effectiveness analysis; duloxetine; painful diabetic neuropathy; pregabalin