The cost-effectiveness of pregabalin in the treatment of fibromyalgia:
US perspective.
Lloyd A, Boomershine CS, Choy EH, Chandran A, Zlateva G.
IMS Health , London , UK.
Abstract
Objective: To evaluate the cost-effectiveness of pregabalin in the
treatment of fibromyalgia in a US patient population.
Methods: A decision-analytic model was developed comparing pregabalin
150=E2=80=89mg twice a day (BID) and pregabalin 225=E2=80=89mg BID to place=
bo,
duloxetine, gabapentin, tramadol, milnacipran, and amitriptyline in
patients with severe fibromyalgia (Fibromyalgia Impact Questionnaire
score >59; pain score >6.5). The model estimated response rates for
all treatments at 12 weeks based on three randomized trials with
pregabalin and a systematic review of published randomized controlled
trials.
Response was categorized as =E2=89=A530% improvement in baseline pain score
plus global impression of change rating of much improved or very much
improved.
After 12 weeks of treatment, responders to treatment entered a
treatment Markov model in which response was maintained, lost, or
treatment discontinued. The cost-effectiveness end-points were cost
per responder at 12 weeks and 1 year. Resource use was estimated from
published studies and costs were estimated from the societal
perspective.
Results: Over 12 weeks, total cost per patient was $229 higher with
pregabalin 150=E2=80=89mg BID than placebo, whereas pregabalin 225=E2=80=89=
mg BID was
$866 less costly than placebo.
At 1 year, pregabalin was cost saving and more effective than placebo,
duloxetine, tramadol, milnacipran, and gabapentin. Compared with
amitriptyline, pregabalin was not cost-effective at both dosages,
although when excluding old and methodologically weak studies of
clinical effectiveness of amitriptyline, pregabalin 225=E2=80=89mg BID beca=
me
cost saving and pregabalin 150=E2=80=89mg BID was cost-effective.
Limitations: Comparisons between pregabalin and other active agents
are based on indirect comparisons, not head-to-head trials, and so
should be interpreted with caution. Limitations for comparators
include an inability to access sub-group data, inconsistency of
response definitions, inclusion of older trials, and absence of
long-term studies.
Conclusions: This model found pregabalin to be cost-effective in
treating patients with severe fibromyalgia.
PMID: 22339078 [PubMed - as supplied by publisher]
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