Cost-effectiveness analysis of five pharmacological strategies for the first-line treatment of patients with neuropathic pain in Colombia
DOI:
https://doi.org/10.17533/udea.iatreia.26727Keywords:
cost-effectiveness evaluation, economics, neuralgia, pain management, pharmacologyAbstract
Objective: To determine the cost-effectiveness relationship of five pharmacological strategies for the first-line treatment of patients with neuropathic pain in Colombia.
Materials and methods: A decision tree was constructed comparing amitriptyline, duloxetine, gabapentin, oxcarbazepine, pregabalin, tramadol and no treatment. The transition probabilities were obtained from a study identified in a systematic review of clinical literature. Costs were measured by expert consensus using the standard case methodology, and resource valuation was carried out using national-level pricing manuals. Deterministic sensitivity, of scenarios, and probabilistic analyses were carried out.
Results: pregabalin proved to be the strategy with the best cost -effectiveness relationship, followed by gabapentin and amitriptyline. This result stands in almost all the sensitivity analyses performed, and only changes when the probability of pain reduction of more than 30 % was less than 14 % for pregabalin.
Conclusions: pregabalin is a cost-effective alternative, and could be considered as the first-line treatment of patients with neuropathic pain in Colombia. Gabapentin and amitriptyline obtained a similar costeffectiveness relationship, and could be considered as alternatives according to the particular characteristics of each patient and the physician judgement and experience.
Downloads
References
(1.) International Association for the Study of Pain [Internet]. Washington D.C.: IASP; 2012. [cited 2015 May 1]. IASP taxonomy. Available from: http://www.iasppain.org/Taxonomy#Neuropathicpain
(2.) Beniczky S, Tajti J, Tímea Varga E, Vécsei L. Evidence-based pharmacological treatment of neuropathic pain syndromes. J Neural Transm (Vienna). 2005 Jun;112(6):735-49. DOI 10.1007/s00702-005-0300-x.
(3.) Malavera Angarita MA, Carrillo Villa S, Gomezese Ribero OF, García R, Silva Sieger FA. Fisiopatología y tratamiento del dolor de miembro fantasma. Rev Col Anestesiol. 2014;42(1):40-6. DOI 10.1016/j.rca.2013.09.012.
(4.) Dijkstra PU, Geertzen JH, Stewart R, van der Schans CP. Phantom pain and risk factors: a multivariate analysis. J Pain Symptom Manage. 2002 Dec;24(6):578-85. DOI 10.1016/S0885-3924(02)00538-9.
(5.) Smith DG, Ehde DM, Legro MW, Reiber GE, del Aguila M, Boone DA. Phantom limb, residual limb, and back pain after lower extremity amputations. Clin Orthop Relat Res. 1999 Apr;(361):29-38.
(6.) Ehde DM, Czerniecki JM, Smith DG, Campbell KM, Edwards WT, Jensen MP, et al. Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Arch Phys Med Rehabil. 2000 Aug;81(8):1039-44. DOI 10.1053/apmr.2000.7583.
(7.) Fundación Universitaria de Ciencias de la Salud. Análisis de impacto presupuestal de gabapentina y pregabalina como tratamiento de primera línea para adultos con dolor neuropático. Neuropatía diabética y neuralgia post herpética [Internet]. Bogotá: Instituto de Evaluación Tecnológica en Salud; 2013 [consultado 2016 May 1]. Disponible en: http://www.iets.org.co/reportes-iets/Documentacin%20Reportes/Documentos%20AIP/Informe%20AIP%20Gabapentina%20VF%20(1).pdf#search=An%C3%A1lisis%20de%20impacto%20presupuestal%20de%20gabapentina
(8.) Ministerio de Salud y Protección Social. [Internet]. Bogotá: MinSalud; 2015 [consultado 2016 May 1]. Guía de práctica clínica para el diagnóstico y tratamiento preoperatorio, intraoperatorio y postoperatorio de la persona amputada, la prescripción de la prótesis y la rehabilitación integral. Disponible en: gpc.minsalud.gov.co
(9.) National Institute for Health and Care Excellence [Internet]. London: NICE; 2013 [cited 2016 May 1]. Neuropathic pain in adults: pharmacological management in non-specialist settings. Available from: https://www.nice.org.uk/guidance/cg173
(10.) Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005 Jan;113(1-2):9-19. DOI 10.1016/j.pain.2004.09.012.
(11.) Huse E, Larbig W, Flor H, Birbaumer N. The effect of opioids on phantom limb pain and cortical reorganization. Pain. 2001 Feb;90(1-2):47-55. DOI 10.1016/S0304-3959(00)00385-7.
(12.) Robinson LR, Czerniecki JM, Ehde DM, Edwards WT, Judish DA, Goldberg ML, et al. Trial of amitriptyline for relief of pain in amputees: results of a randomized controlled study. Arch Phys Med Rehabil. 2004 Jan;85(1):1-6. DOI 10.1016/S0003-9993(03)00476-3.
(13.) Smith DG, Ehde DM, Hanley MA, Campbell KM, Jensen MP, Hoffman AJ, et al. Efficacy of gabapentin in treating chronic phantom limb and residual limb pain. J Rehabil Res Dev. 2005 Sep-Oct;42(5):645-54. DOI 10.1682/JRRD.2005.05.0082.
(14.) Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med. 2002 Sep-Oct;27(5):481-6.
(15.) Wu CL, Agarwal S, Tella PK, Klick B, Clark MR, Haythornthwaite JA, et al. Morphine versus mexiletine for treatment of postamputation pain: a randomized, placebo-controlled, crossover trial. Anesthesiology. 2008 Aug;109(2):289-96. DOI 10.1097/ALN.0b013e31817f4523.
(16.) Briggs AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 2000 May;17(5):479-500. DOI 10.2165/00019053-200017050-00006.
(17.) Claxton K. Exploring uncertainty in cost-effectiveness analysis. Pharmacoeconomics. 2008;26(9):781-98. DOI 10.2165/00019053-200826090-00008.
(18.) Guerrero R, Guevara C, Parody E. Guía metodológica para la realización de evaluaciones económicas en el marco de Guías de Práctica Clínica [Internet]. Bogotá: PROESA; 2016 [consultado 2016 May 1]. Disponible en: http://gpc.minsalud.gov.co/recursos/Documents/Guia_Metodologica_Actualizacio%CC%81n_Economica_2014.pdf
(19.) Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making. 1998 Apr-Jun;18(2 Suppl):S68-80. DOI 10.3386/t0227.
(20.) Shillcutt SD, Walker DG, Goodman CA, Mills AJ. Cost effectiveness in low- and middle-income countries: a review of the debates surrounding decision rules. Pharmacoeconomics. 2009;27(11):903-17. DOI 10.2165/10899580-000000000-00000.
(21.) World Health Organization. Macroeconomics and Health: Investing in health for economic development. Report for the Commission on macroeconomics and health [Internet]. Geneva: WHO; 2001 [cited 2016 May 1]. Available from: http://www1.worldbank.org/publicsector/pe/PEAMMarch2005/CMHReport.pdf
(22.) Flor H, Diers M, Andoh J. The neural basis of phantom limb pain. Trends Cogn Sci. 2013 Jul;17(7):307-8. DOI 10.1016/j.tics.2013.04.007.
(23.) McCormick Z, Chang-Chien G, Marshall B, Huang M, Harden RN. Phantom limb pain: a systematic neuroanatomical-based review of pharmacologic treatment. Pain Med. 2014 Feb;15(2):292-305. DOI 10.1111/pme.12283.
(24.) van der Schans CP, Geertzen JH, Schoppen T, Dijkstra PU. Phantom pain and health-related quality of life in lower limb amputees. J Pain Symptom Manage. 2002 Oct;24(4):429-36. DOI 10.1016/S0885-3924(02)00511-0.
(25.) Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Iatreia
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Papers published in the journal are available for use under the Creative Commons license, specifically Attribution-NonCommercial-ShareAlike 4.0 International.
The papers must be unpublished and sent exclusively to the Journal Iatreia; the author uploading the contribution is required to submit two fully completed formats: article submission and authorship responsibility.
