Tarride Jean-Eric, Gordon Allan, Vera-Llonch Montserrat, Dukes Ellen, Rousseau Catherine
Program for Assessment of Technology in Health, St Joseph's Healthcare, Hamilton, Ontario, Canada.
Clin Ther. 2006 Nov;28(11):1922-34. doi: 10.1016/j.clinthera.2006.11.017.
Neuropathic pain (NeP) is a chronic condition that occurs frequently with diabetes and herpes zoster infection. In addition to potentially lasting many years, the relationship between chronic pain, anxiety/depression, and sleep, also referred to as the triad of pain, causes functional impairment in many areas of life.
The aim of this study was to examine the 12-week cost-effectiveness of 2 treatments of NeP, pregabalin versus gabapentin, in managing diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN) in a Canadian setting.
A stochastic simulation model evaluating NeP treatment was adapted to the Canadian setting. Using data from clinical trials of pregabalin (150-600 mg/d) and gabapentin (900-3600 mg/d), the model simulated 12-week treatment outcomes for patients with DPN or PHN. Resource utilization was identified through an Internet-based survey among 80 Canadian physicians. Utility values (as measured using the EuroQol EQ-5D) were obtained from 126 NeP patients participating in a cross-sectional study conducted at Canadian primary care sites. The economic analysis was expressed as incremental cost per quality-adjusted life year (QALY) gained and as incremental cost per day with no or mild pain. Model sensitivity to changes in key parameters was assessed.
Following 12-week treatment, compared with gabapentin, pregabalin was projected to result in 6 and 9 additional days with no or mild pain for patients with DPN and PHN, respectively. Pregabalin therapy was estimated to provide an additional 0.0047 QALY and 0.0086 QALY over gabapentin administration, for DPN and PHN, respectively. Mean (SE) direct costs per DPN patient were estimated as 837.53 Can dollars (37.31 dollars) (2004 dollars) with gabapentin and 818.49 dollars (36.50 dollars) with pregabalin, and per PHN patient as 720.61 dollars (33.70 dollars) with gabapentin and 667.07 dollars (25.33 dollars) with pregabalin. Model findings were sensitive to variation in the dose and corresponding cost of the comparator, but not in other parameters.
Based on the results of this analysis, in the treatment of NeP associated with DPN or PHN, pregabalin was a dominant or cost-effective treatment strategy compared with gabapentin.
神经性疼痛（NeP）是一种常与糖尿病和带状疱疹感染相关的慢性疾病。除了可能持续多年外，慢性疼痛、焦虑/抑郁和睡眠之间的关系，也就是所谓的疼痛三联征，会导致生活许多方面的功能障碍。
本研究的目的是在加拿大背景下，检验两种治疗神经性疼痛的药物——普瑞巴林与加巴喷丁，治疗12周对糖尿病性周围神经病（DPN）和带状疱疹后神经痛（PHN）的成本效益。
一个评估神经性疼痛治疗的随机模拟模型被应用于加拿大背景。利用普瑞巴林（150 - 600毫克/天）和加巴喷丁（900 - 3600毫克/天）临床试验的数据，该模型模拟了DPN或PHN患者12周的治疗结果。通过对80名加拿大医生进行基于互联网的调查来确定资源利用情况。效用值（使用欧洲五维度健康量表EQ - 5D测量）来自于在加拿大初级保健机构进行的一项横断面研究中的126名神经性疼痛患者。经济分析以每获得一个质量调整生命年（QALY）的增量成本以及无疼痛或轻度疼痛天数的增量成本来表示。评估了模型对关键参数变化的敏感性。
经过12周治疗后，与加巴喷丁相比，预计普瑞巴林可使DPN患者和PHN患者分别多6天和9天无疼痛或轻度疼痛。估计普瑞巴林治疗比加巴喷丁治疗分别为DPN患者和PHN患者多提供0.0047个QALY和0.0086个QALY。加巴喷丁治疗DPN患者的平均（标准误）直接成本估计为837.53加元（37.31加元）（2004年加元），普瑞巴林为818.49加元（36.50加元）；加巴喷丁治疗PHN患者的平均（标准误）直接成本估计为720.61加元（33.70加元），普瑞巴林为667.07加元（25.33加元）。模型结果对对照药物剂量和相应成本的变化敏感，但对其他参数不敏感。
基于本分析结果，在治疗与DPN或PHN相关的神经性疼痛时，与加巴喷丁相比，普瑞巴林是一种占优或具有成本效益的治疗策略。
