Rodríguez M J, Díaz S, Vera-Llonch M, Dukes E, Rejas J
Pain and Palliative Care Unit, Carlos Haya University Hospital, Málaga, Spain.
Curr Med Res Opin. 2007 Oct;23(10):2585-96. doi: 10.1185/030079907X233151.
To estimate the cost-effectiveness of branded pregabalin (PGB) versus generic gabapentin (GBP) in patients with neuropathic pain (NeP) due to painful diabetic polyneuropathy (DPN) or post-herpetic neuralgia (PHN) in Spain.
Using stochastic simulation, we estimated the cost-effectiveness of PGB 150-600 mg/d vs. GBP 900-3600 mg/d in a hypothetical cohort of 1000 patients. The model used data from three randomized controlled clinical trials. Pain was evaluated using a 0-10 scale. Mean baseline pain was 6.9 in both treatment groups. The model assigned untreated pain scores over 84 days. Treated scores were calculated using weekly changes in pain scores from trials. Outcomes included the numbers of days with no or mild pain (score < 4), days with >or= 30% and >or= 50% reductions in pain intensity, quality-adjusted life-years (QALYs), and estimated health costs.
Compared with GBP, PGB yielded an estimated mean of 8 (standard error, 0.4) additional days with no or mild pain, 6 (0.4) days with >or= 30% reduction in pain intensity, 9 (0.5) days with >or= 50% reduction in pain intensity, and a gain of 0.1186 (0.0002) QALYs for 12 weeks. The estimated total health costs of therapies were euro 1049 (euro 35) for PGB and euro 951 (euro 38) for GBP, respectively. Incremental cost-effectiveness ratio (ICER) for PGB versus GBP were a mean of euro 12 (95% confidence interval, euro 1-24) per additional day with no or mild pain, euro 431 (dominant-euro 876) per additional patient with no or mild pain, and euro 20 535 (euro 1607-40 345) per QALY gained.
According with data used in this modeling in patients with NeP due to DPN and/or PHN, PGB was shown to be more cost-effective than generic gabapentin in Spain.
评估在西班牙，品牌普瑞巴林（PGB）与通用型加巴喷丁（GBP）治疗因糖尿病性周围神经病变（DPN）或带状疱疹后神经痛（PHN）所致神经性疼痛（NeP）患者的成本效益。
采用随机模拟，我们在一个假设的1000例患者队列中评估了150 - 600 mg/d的PGB与900 - 3600 mg/d的GBP的成本效益。该模型使用了三项随机对照临床试验的数据。疼痛采用0 - 10分制进行评估。两个治疗组的平均基线疼痛均为6.9分。该模型设定了84天的未治疗疼痛评分。治疗评分根据试验中疼痛评分的每周变化进行计算。结果包括无疼痛或轻度疼痛（评分<4）的天数、疼痛强度降低≥30%和≥50%的天数、质量调整生命年（QALY）以及估计的医疗成本。
与GBP相比，PGB估计平均多8天（标准误，0.4）无疼痛或轻度疼痛，多6天（0.4）疼痛强度降低≥30%，多9天（0.5）疼痛强度降低≥50%，且在12周内获得0.1186（0.0002）个QALY。治疗的估计总医疗成本分别为PGB 1049欧元（35欧元）和GBP 951欧元（38欧元）。PGB相对于GBP的增量成本效益比（ICER）为每多一天无疼痛或轻度疼痛平均12欧元（95%置信区间，1 - 24欧元），每多一名无疼痛或轻度疼痛患者431欧元（优势 - 876欧元），以及每获得一个QALY 20535欧元（1607 - 40345欧元）。
根据本模型中用于DPN和/或PHN所致NeP患者的数据，在西班牙，PGB显示出比通用型加巴喷丁更具成本效益。
