A Cost-Effectiveness Analysis Of Pregabalin For The Treatment Of Patients With Chronic Cervical Pain With A Neuropathic Component In Japan

Overview

Journal J Pain Res

Publisher Dove Medical Press

Date 2019 Oct 3

PMID 31576163

Citations 3

Authors

Manabu Akazawa

Ataru Igarashi

Nozomi Ebata

Tatsunori Murata

Shigeki Zeniya

Yuri Haga

Kazutaka Nozawa

Koichi Fujii

Toshihiko Taguchi

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the cost-effectiveness of pregabalin versus other analgesics among patients with chronic cervical pain with neuropathic components during routine clinical practice in Japan.

Patients And Methods: The analysis considered patients with chronic cervical pain with a neuropathic pain component (radiating pain to the upper limb) and who were treated with pregabalin with or without other analgesics (pregabalin-containing treatments) or other analgesics alone (usual care) for 8 weeks. Other analgesics included non-steroidal anti-inflammatory drugs (NSAIDs), weak opioids, antidepressants, and antiepileptic drugs. A Markov cohort simulation model was constructed to estimate costs and effectiveness (in terms of quality-adjusted life-years, QALYs) of each treatment over a 12-month time horizon. In the model, patients transitioned among three states of pain severity (no/mild, moderate, and severe). Data were derived from a previous observational study (pregabalin-containing treatments, n = 138; usual care, n = 211). Cost inputs included medical costs and productivity losses. QALYs were calculated using the EuroQol five-dimensional, five-level questionnaire. The cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to assess the robustness of results.

Results: From the payer's perspective, pregabalin-containing treatments were more costly (JPY 61,779 versus JPY 26,428) but also more effective (0.763 QALYs versus 0.727 QALYs) than the usual care, with an ICER of JPY 970,314 per QALY gained. From the societal perspective, which also included productivity losses, the ICER reduced to JPY 458,307 per QALY gained. One-way sensitivity analyses demonstrated the robustness of the results. Given a hypothetical threshold value of one additional QALY of JPY 5,000,000, the probability of pregabalin-containing treatments being cost-effective was 100%.

Conclusion: Compared with using other analgesics alone, the use of pregabalin, alone or in addition to other analgesics, was cost-effective for the treatment of chronic cervical pain with a neuropathic pain component in Japan.

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References

Neumann P, Cohen J, Weinstein M . Updating cost-effectiveness--the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014; 371(9):796-7. DOI: 10.1056/NEJMp1405158. View

Cohen S . Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015; 90(2):284-99. DOI: 10.1016/j.mayocp.2014.09.008. View

. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388(10053):1545-1602. PMC: 5055577. DOI: 10.1016/S0140-6736(16)31678-6. View

Romano C, Romano D, Bonora C, Mineo G . Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain. J Orthop Traumatol. 2009; 10(4):185-91. PMC: 2784066. DOI: 10.1007/s10195-009-0077-z. View

Liu R, Kurihara C, Tsai H, Silvestri P, Bennett M, Pasquina P . Classification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study. Reg Anesth Pain Med. 2016; 42(1):52-61. DOI: 10.1097/AAP.0000000000000505. View

Gordon J, Lister S, Prettyjohns M, McEwan P, Tetlow A, Gabriel Z . A cost-utility study of the use of pregabalin in treatment-refractory neuropathic pain. J Med Econ. 2011; 15(2):207-18. DOI: 10.3111/13696998.2011.632797. View

Dworkin R, OConnor A, Backonja M, Farrar J, Finnerup N, Jensen T . Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain. 2007; 132(3):237-251. DOI: 10.1016/j.pain.2007.08.033. View

Morlion B . Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components. Curr Med Res Opin. 2010; 27(1):11-33. DOI: 10.1185/03007995.2010.534446. View

Taylor R . Epidemiology of refractory neuropathic pain. Pain Pract. 2007; 6(1):22-6. DOI: 10.1111/j.1533-2500.2006.00054.x. View

10.

Iyer S, Kim H . Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016; 9(3):272-80. PMC: 4958381. DOI: 10.1007/s12178-016-9349-4. View

11.

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D . Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011; 20(10):1727-36. PMC: 3220807. DOI: 10.1007/s11136-011-9903-x. View

12.

Freynhagen R, Baron R . The evaluation of neuropathic components in low back pain. Curr Pain Headache Rep. 2009; 13(3):185-90. DOI: 10.1007/s11916-009-0032-y. View

13.

Nakamura M, Nishiwaki Y, Ushida T, Toyama Y . Prevalence and characteristics of chronic musculoskeletal pain in Japan. J Orthop Sci. 2011; 16(4):424-32. PMC: 3140943. DOI: 10.1007/s00776-011-0102-y. View

14.

Shiroiwa T, Sung Y, Fukuda T, Lang H, Bae S, Tsutani K . International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?. Health Econ. 2009; 19(4):422-37. DOI: 10.1002/hec.1481. View

15.

Torrance N, Smith B, Bennett M, Lee A . The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain. 2006; 7(4):281-9. DOI: 10.1016/j.jpain.2005.11.008. View

16.

Satoh J, Yagihashi S, Baba M, Suzuki M, Arakawa A, Yoshiyama T . Efficacy and safety evaluation of pregabalin treatment over 52 weeks in patients with diabetic neuropathic pain extended after a double-blind placebo-controlled trial. J Diabetes Investig. 2014; 2(6):457-63. PMC: 4014905. DOI: 10.1111/j.2040-1124.2011.00122.x. View

17.

Prettyjohns M, Sandelin R, Lister S, Norrefalk J . A cost-utility study of the use of pregabalin added to usual care in refractory neuropathic pain patients in a Swedish setting. J Med Econ. 2012; 15(6):1097-109. DOI: 10.3111/13696998.2012.704458. View

18.

Onouchi K, Koga H, Yokoyama K, Yoshiyama T . An open-label, long-term study examining the safety and tolerability of pregabalin in Japanese patients with central neuropathic pain. J Pain Res. 2014; 7:439-47. PMC: 4122555. DOI: 10.2147/JPR.S63028. View

19.

Igarashi A, Akazawa M, Murata T, Taguchi T, Sadosky A, Ebata N . Cost-effectiveness analysis of pregabalin for treatment of chronic low back pain in patients with accompanying lower limb pain (neuropathic component) in Japan. Clinicoecon Outcomes Res. 2015; 7:505-20. PMC: 4605243. DOI: 10.2147/CEOR.S89833. View

20.

Takura T, Ushida T, Kanchiku T, Ebata N, Fujii K, DiBonaventura M . The societal burden of chronic pain in Japan: an internet survey. J Orthop Sci. 2015; 20(4):750-60. DOI: 10.1007/s00776-015-0730-8. View