Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Ann Palliat Med. 2021 Apr;10(4):4493-4501. doi: 10.21037/apm-21-529. Epub 2021 Apr 16.
Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster and is defined as pain that lasts for one month or more after the outbreak itself heals. While the annual incidence of herpes zoster is approximately 3-5%, 9-34% of these patients will develop PHN. Approximately 30-50% of these cases last for more than a year but some cases can persist for 10 years or more. To date, the economic burden of PHN in China has not been studied. The first-line topical therapy for PHN is application of lidocaine-medicated plasters (LMPs) which have shown good efficacy and tolerability. Furthermore, LMPs were added to China's National Health Insurance List in 2019, thereby significantly relieving the financial burden on patients. A cost-effectiveness analysis was performed on LMPs compared with pregabalin in the treatment of PHN to provide a reference for the basis for clinical treatments and health decisions in patients with PHN.
A Markov model was built according to the PHN disease characteristics. The efficacy data were extracted from a randomized controlled trial conducted in China, and the transition probability, utility value, and medical cost of each state in the model were collected through a systematic review of the literature and public databases. The outcome measure was cost per quality-adjusted life year (QALY) gained. The incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analysis was conducted to confirm the robustness of the model.
In the base case analysis, treatment for a 6-month period with pregabalin and lidocaine plasters led to a mean QALY gain of 0.34012 and 0.42543, respectively, and mean incremental costs of 5,720 Chinese Yuan (CNY) and 3690 CNY, respectively. The ICER of treatment with 5% lidocaine plaster was negative, indicating that lidocaine plasters had absolute advantage. Monte Carlo simulation resulted in an estimate of 90% probability that the 5% lidocaine plaster treatment was cost-effective.
Within the Chinese medical and health system, LMPs can reduce the economic burden of patients with PHN. LMPs are more cost-effective and more efficient in absolute terms compared to the first-line treatment systemic drug pregabalin in the treatment of PHN.
带状疱疹后神经痛（PHN）是带状疱疹最常见的并发症，定义为疱疹发作愈合后持续一个月或以上的疼痛。带状疱疹的年发病率约为 3-5%，但其中 9-34%的患者会发展为 PHN。大约 30-50%的病例持续一年以上，但有些病例可持续 10 年或更长时间。迄今为止，尚未对中国 PHN 的经济负担进行研究。PHN 的一线局部治疗是应用利多卡因贴膏（LMP），已显示出良好的疗效和耐受性。此外，LMP 于 2019 年被纳入中国国家医保目录，从而显著减轻了患者的经济负担。对 LMP 与普瑞巴林治疗 PHN 的成本效益进行了分析，为 PHN 患者的临床治疗和卫生决策提供了参考依据。
根据 PHN 的疾病特征建立了 Markov 模型。从在中国进行的一项随机对照试验中提取疗效数据，并通过系统评价文献和公共数据库收集模型中每个状态的转移概率、效用值和医疗成本。结果测量指标为每获得一个质量调整生命年（QALY）的成本。计算增量成本效益比（ICER）。进行敏感性分析以确认模型的稳健性。
在基础案例分析中，普瑞巴林和利多卡因贴膏治疗 6 个月分别导致平均 QALY 增加 0.34012 和 0.42543，平均增量成本分别为 5720 元人民币（CNY）和 3690 CNY。5%利多卡因贴膏治疗的 ICER 为负值，表明 5%利多卡因贴膏具有绝对优势。蒙特卡罗模拟得出的估计结果显示，5%利多卡因贴膏治疗有 90%的概率具有成本效益。
在中国的医疗保健体系中，LMP 可以减轻 PHN 患者的经济负担。与一线治疗系统性药物普瑞巴林相比，LMP 在治疗 PHN 方面更具成本效益，效率更高。
