Athanasakis Kostas, Petrakis Ioannis, Karampli Eleftheria, Vitsou Elli, Lyras Leonidas, Kyriopoulos John
BMC Neurol. 2013 Jun 4;13:56. doi: 10.1186/1471-2377-13-56.
The anticonvulsants pregabalin and gabapentin are both indicated for the treatment of peripheral neuropathic pain. The decision on which treatment provides the best alternative, should take into account all aspects of costs and outcomes associated with the two therapeutic options. The objective of this study was to examine the cost - effectiveness of the two agents in the management of patients with painful diabetic neuropathy or post - herpetic neuralgia, under the third party payer perspective in Greece.
The analysis was based on a dynamic simulation model which estimated and compared the costs and outcomes of pregabalin and gabapentin in a hypothetical cohort of 1,000 patients suffering from painful Diabetic Peripheral Neuropathy (DPN) or Post-Herpetic Neuralgia (PHN). In the model, each patient was randomly allocated an average pretreatment pain score, measured using an eleven-point visual analogue scale (0 - 10) and was "run through" the model, simulating their daily pain intensity and allowing for stochastic calculation of outcomes, taking into account medical interventions and the effectiveness of each treatment.
Pregabalin demonstrated a reduction in days with moderate to severe pain when compared to gabapentin. During the 12 weeks the pregabalin arm demonstrated a 0.1178 (SE 0.0002) QALY gain, which proved to be 0.0063 (SE 0.0003) higher than that in the gabapentin arm. The mean medication cost per patient was higher for the pregabalin arm when compared to the gabapentin arm (i.e. €134.40) over the 12 week treatment period. However, this higher cost was partially offset by the reduced direct medical costs (i.e. the cost of specialist visits, the cost of diagnostic tests and the other applied interventions). Comparing costs with respective outcomes, the ICERs for pregabalin versus gabapentin were €13 (95%CI: 8 - 18) per additional day with no or mild pain and €19,320 (95%CI: 11,743 - 26,755) per QALY gained.
Neuropathic pain carries a great disease burden for patients and society and, is also, associated with a significant economic burden. The treatment of pain associated with DPN and PHN with pregabalin is a cost-effective intervention for the social security in Greece compared to gabapentin. Thus, these findings need to be taken into consideration in the decision - making process when considering which therapy to use for the treatment of neuropathic pain.
抗惊厥药普瑞巴林和加巴喷丁均适用于治疗周围神经性疼痛。关于哪种治疗方法是最佳选择的决策，应考虑与这两种治疗方案相关的成本和结果的各个方面。本研究的目的是从希腊第三方支付方的角度，考察这两种药物在治疗糖尿病性神经病变性疼痛或带状疱疹后神经痛患者中的成本效益。
该分析基于一个动态模拟模型，该模型估计并比较了普瑞巴林和加巴喷丁在一个由1000名患有疼痛性糖尿病周围神经病变（DPN）或带状疱疹后神经痛（PHN）的患者组成的假设队列中的成本和结果。在模型中，为每位患者随机分配一个平均治疗前疼痛评分，使用11点视觉模拟量表（0 - 10）进行测量，并使其“运行”该模型，模拟其每日疼痛强度，并考虑医疗干预和每种治疗的有效性，对结果进行随机计算。
与加巴喷丁相比，普瑞巴林在中度至重度疼痛天数上有所减少。在12周期间，普瑞巴林组的质量调整生命年（QALY）增益为0.1178（标准误0.0002），这被证明比加巴喷丁组高0.0063（标准误0.0003）。在12周的治疗期内，普瑞巴林组每位患者的平均药物成本高于加巴喷丁组（即134.40欧元）。然而，这种较高的成本被降低的直接医疗成本（即专科就诊成本、诊断测试成本和其他应用干预措施的成本）部分抵消。将成本与各自的结果进行比较，普瑞巴林相对于加巴喷丁的增量成本效果比（ICER）为每增加一天无或轻度疼痛为13欧元（95%置信区间：8 - 18），每获得一个QALY为19320欧元（95%置信区间：11743 - 26755）。
神经性疼痛给患者和社会带来了巨大的疾病负担，并且还与重大的经济负担相关。与加巴喷丁相比，用普瑞巴林治疗与DPN和PHN相关的疼痛对希腊社会保障来说是一种具有成本效益的干预措施。因此，在考虑使用哪种疗法治疗神经性疼痛的决策过程中，需要考虑这些发现。
