Dakin Helen, Nuijten Mark, Liedgens Hiltrud, Nautrup Barbara Poulsen
Abacus International, Bicester, Oxfordshire, United Kingdom.
Clin Ther. 2007 Jul;29(7):1491-507. doi: 10.1016/j.clinthera.2007.07.006.
Approximately 50% of elderly patients develop postherpetic neuralgia (PHN) after herpes zoster infection (shingles). A lidocaine 5% medicated plaster marketed in the United Kingdom in January 2007 has been shown to be an effective topical treatment for PHN with minimal risk of systemic adverse effects.
This paper assessed the cost-effectiveness of using a lidocaine plaster in place of gabapentin in English primary care practice to treat those PHN patients who had insufficient pain relief with standard analgesics and could not tolerate or had contraindications to tricyclic antidepressants (TCAs). The analysis took the perspective of the National Health Service (NHS).
The costs and benefits of gabapentin and the lidocaine plaster were calculated over a 6-month time horizon using a Markov model. The model structure allowed for differences in costs, utilities, and transition probabilities between the initial 30-day run-in period and maintenance therapy and also accounted for add-in medications and drugs received by patients who discontinued therapy. Most transition probabilities were based on non-head-to-head clinical trials identified through a systematic review. Data on resource utilization, discontinuation rates, and add-in or switch medications were obtained from a Delphi panel; cost data were from official price tariffs. Published utilities were adjusted for age and were supplemented and validated by the Delphi panel.
Six months of therapy with the lidocaine plaster cost pound 549 per patient, compared with pound 718 for gabapentin, and generated 0.05 more quality-adjusted life-years (QALYs). The lidocaine plaster therefore dominated gabapentin (95% CI, dominant- pound 2163/QALY gained). Probabilistic sensitivity analysis showed that there was a 90.15% chance that the lidocaine plaster was both less costly and more effective than gabapentin and a 99.99% chance that it cost < pound 20,000/QALY relative to gabapentin. Extensive deterministic sensitivity analyses confirmed the robustness of the conclusions.
This study found that the lidocaine 5% medicated plaster was a cost-effective alternative to gabapentin for PHN patients who were intolerant to TCAs and in whom analgesics were ineffective, from the perspective of the NHS.
带状疱疹感染（带状疱疹）后，约50%的老年患者会发生带状疱疹后神经痛（PHN）。2007年1月在英国上市的5%利多卡因药用贴剂已被证明是一种有效的PHN局部治疗方法，全身不良反应风险极小。
本文评估了在英国初级医疗实践中，使用利多卡因贴剂替代加巴喷丁治疗那些使用标准镇痛药后疼痛缓解不足且无法耐受三环类抗抑郁药（TCA）或有其禁忌证的PHN患者的成本效益。该分析采用了英国国家医疗服务体系（NHS）的视角。
使用马尔可夫模型在6个月的时间范围内计算加巴喷丁和利多卡因贴剂的成本和效益。该模型结构考虑了初始30天导入期和维持治疗之间在成本、效用和转移概率方面的差异，还考虑了停药患者接受的添加药物和药物。大多数转移概率基于通过系统评价确定的非头对头临床试验。资源利用、停药率以及添加或转换药物的数据来自德尔菲小组；成本数据来自官方价格表。已发表的效用根据年龄进行了调整，并由德尔菲小组进行了补充和验证。
利多卡因贴剂治疗6个月每位患者花费549英镑，而加巴喷丁为718英镑，且产生的质量调整生命年（QALY）多0.05。因此，利多卡因贴剂优于加巴喷丁（95%CI，优势 - 每获得一个QALY节省2163英镑）。概率敏感性分析表明，利多卡因贴剂成本低于加巴喷丁且效果更好的概率为90.15%，相对于加巴喷丁，其成本<20,000英镑/QALY的概率为99.99%。广泛的确定性敏感性分析证实了结论的稳健性。
本研究发现，从NHS的角度来看，对于不耐受TCA且镇痛药无效的PHN患者，5%利多卡因药用贴剂是加巴喷丁具有成本效益的替代方案。
