Critchlow Simone, Hirst Matthew, Akehurst Ron, Phillips Ceri, Philips Zoe, Sullivan Will, Dunlop Will C N
a BresMed Health Solutions , Sheffield , UK.
b Mundipharma International , Cambridge , UK.
J Med Econ. 2017 Feb;20(2):129-139. doi: 10.1080/13696998.2016.1229671. Epub 2016 Sep 16.
Complexities in the neuropathic-pain care pathway make the condition difficult to manage and difficult to capture in cost-effectiveness models. The aim of this study is to understand, through a systematic review of previous cost-effectiveness studies, some of the key strengths and limitations in data and modeling practices in neuropathic pain. Thus, the aim is to guide future research and practice to improve resource allocation decisions and encourage continued investment to find novel and effective treatments for patients with neuropathic pain.
The search strategy was designed to identify peer-reviewed cost-effectiveness evaluations of non-surgical, pharmaceutical therapies for neuropathic pain published since January 2000, accessing five key databases. All identified publications were reviewed and screened according to pre-defined eligibility criteria. Data extraction was designed to reflect key data challenges and approaches to modeling in neuropathic pain and based on published guidelines.
The search strategy identified 20 cost-effectiveness analyses meeting the inclusion criteria, of which 14 had original model structures. Cost-effectiveness modeling in neuropathic pain is established and increasing across multiple jurisdictions; however, amongst these studies, there is substantial variation in modeling approach, and there are common limitations. Capturing the effect of treatments upon health outcomes, particularly health-related quality-of-life, is challenging, and the health effects of multiple lines of ineffective treatment, common for patients with neuropathic pain, have not been consistently or robustly modeled.
To improve future economic modeling in neuropathic pain, further research is suggested into the effect of multiple lines of treatment and treatment failure upon patient outcomes and subsequent treatment effectiveness; the impact of treatment-emergent adverse events upon patient outcomes; and consistent and appropriate pain measures to inform models. The authors further encourage transparent reporting of inputs used to inform cost-effectiveness models, with robust, comprehensive and clear uncertainty analysis and, where feasible, open-source modeling is encouraged.
神经性疼痛护理路径的复杂性使得该病症难以管理，且难以纳入成本效益模型。本研究的目的是通过对以往成本效益研究的系统评价，了解神经性疼痛数据和建模实践中的一些关键优势和局限性。因此，目的是指导未来的研究和实践，以改善资源分配决策，并鼓励持续投资，为神经性疼痛患者寻找新颖有效的治疗方法。
检索策略旨在识别自2000年1月以来发表的关于神经性疼痛非手术药物治疗的同行评审成本效益评估，检索五个关键数据库。所有识别出的出版物均根据预先定义的纳入标准进行评审和筛选。数据提取旨在反映神经性疼痛建模中的关键数据挑战和方法，并基于已发表的指南。
检索策略识别出20项符合纳入标准的成本效益分析，其中14项具有原始模型结构。神经性疼痛的成本效益建模在多个司法管辖区已确立且不断增加；然而，在这些研究中，建模方法存在很大差异，且存在共同的局限性。捕捉治疗对健康结果的影响，尤其是与健康相关的生活质量，具有挑战性，对于神经性疼痛患者常见的多线无效治疗的健康影响，尚未得到一致或有力的建模。
为改善未来神经性疼痛的经济建模，建议进一步研究多线治疗和治疗失败对患者结局及后续治疗效果的影响；治疗出现的不良事件对患者结局的影响；以及用于为模型提供信息的一致且适当的疼痛测量方法。作者进一步鼓励透明报告用于为成本效益模型提供信息的输入，进行有力、全面且清晰的不确定性分析，并在可行的情况下鼓励开源建模。
