Research Centre on the Portuguese Economy (CISEP), Instituto Superior de Economia e Gestão, Technical University of Lisbon, Lisbon, Portugal.
Cost Eff Resour Alloc. 2013 Apr 12;11(1):8. doi: 10.1186/1478-7547-11-8.
Generalized anxiety disorder is characterized by excessive anxiety and worry about several events and activities. The estimated 1-year prevalence for adults is around 2% and the lifetime prevalence could reach more than 6%. The disease is associated with reduced quality of life, being comparable to that of major depressive disorder and to chronic illnesses such as diabetes and arthritis, and high consumption of health care resources.
A previously published patient-level simulation cost-utility model was adapted to the Portuguese context in order to evaluate clinical and economic consequences of using pregabalin in place of venlafaxine XR in the treatment of generalized anxiety disorder. The model predicts the evolution of 1,000 patients with generalized anxiety disorder, simulating their pathway in weekly cycles over one year treatment. This is done by setting a pre-treatment Hamilton Anxiety Scale score and projecting the weekly impact of the pharmacotherapy on this score. The model uses clinical data from an 8-week flexible dose direct comparison clinical trial between the two drugs; utility values based on a Spanish study; and Portuguese economic data, being the resource consumption obtained via an expert panel.
Pregabalin patients benefited from 0.738 quality adjusted life years while those on venlafaxine XR achieved 0.712. Moreover, the number of weeks with no or minimal anxiety symptoms was estimated to be 12.9 for pregabalin and only 3.8 for venlafaxine XR. Those clinical gains were achieved at the expense of an extra 715€ per patient, implying an incremental cost per quality adjusted life year of 27,199€ and an incremental cost per week with no or minimal symptoms of 79€. Sensitivity analysis shows that results are robust to main assumptions.
Assuming a threshold of 30,000€ per quality adjusted life year, pregabalin is cost-effective in comparison with venlafaxine XR in the treatment of generalized anxiety disorder in Portugal.
广泛性焦虑障碍的特征是对多种事件和活动过度焦虑和担忧。成年人的 1 年患病率约为 2%，终身患病率可能超过 6%。该疾病与生活质量下降有关，与重度抑郁症和糖尿病、关节炎等慢性疾病相当，并且消耗大量医疗资源。
根据葡萄牙的具体情况对之前发表的患者层面模拟成本效用模型进行了调整，以评估使用普瑞巴林替代文拉法辛 XR 治疗广泛性焦虑障碍的临床和经济后果。该模型预测了 1000 名广泛性焦虑障碍患者的发展情况，通过每周循环模拟他们在一年治疗中的路径。这是通过设定治疗前汉密尔顿焦虑量表评分并预测每周药物治疗对该评分的影响来实现的。该模型使用了两项药物 8 周灵活剂量直接比较临床试验的临床数据；基于西班牙研究的效用值；以及葡萄牙经济数据，通过专家小组获得资源消耗数据。
普瑞巴林患者的质量调整生命年为 0.738，而文拉法辛 XR 患者的质量调整生命年为 0.712。此外，普瑞巴林治疗后无或轻度焦虑症状的周数估计为 12.9，而文拉法辛 XR 仅为 3.8。这些临床获益是在每位患者额外增加 715 欧元的情况下实现的，这意味着每质量调整生命年的增量成本为 27199 欧元，无或轻度症状的每周增量成本为 79 欧元。敏感性分析表明，结果对主要假设具有稳健性。
假设葡萄牙每质量调整生命年 30000 欧元的阈值，与文拉法辛 XR 相比，普瑞巴林在治疗广泛性焦虑障碍方面具有成本效益。
