A Cost-Effectiveness Analysis of the Effect of Pregabalin Versus Usual Care in the Treatment of Refractory Neuropathic Pain in Routine Medical Practice in Spain

Objective. The objective of this study was to estimate the cost-effectiveness of pregabalin vs usual care (UC) in outpatients with refractory neuropathic pain (NeP), treated according to routine medical practice in primary care settings in Spain. Methods. Patients were extracted from a 12-week noninterventional prospective study conducted to ascertain the costs of NeP. Pairs of pregabalin-naive patients receiving UC or pregabalin, matched by age, gender, pain intensity, and refractory to previous treatment, were selected in a 1:1 ratio. Refractory was considered a patient with actual pain (scoring >40 in a 100 mm in a pain visual analog scale) after receiving a course of a standard analgesic, at its recommended doses. Perspectives of the Spanish National Healthcare System and society were included in the analysis. Effectiveness was expressed as quality-adjusted life-year (QALY) gain. Results of the cost-effectiveness analysis were expressed as an incremental cost per QALY (ICER) gained. Probabilistic sensitivity analysis using bootstrapping techniques was also carried out. Results. A total of 160 pairs were extracted. Compared with UC, pregabalin was associated with significantly higher QALY gain; 0.0374 +/- 0.0367 vs 0.0224 +/- 0.0313 (P < 0.001). Despite drug acquisition costs being higher for pregabalin (251 pound +/- 125 vs 104 pound +/- 121; P < 0.001), total and health care costs incurred for pregabalin were similar in both groups; 1,335 pound +/- 1,302 vs 1,387 pound +/- 1,489 (P = 0.587) and 529 pound +/- 438 vs 560 pound +/- 672 (P = 0.628), respectively, yielding a dominant ICER for both total and health care costs in the base case scenario; 95% confidence intervals, respectively, dominant to 17,268 pound, and dominant to 6,508 pound. Sensitivity analysis confirmed results of the basecase scenario. Conclusion. This study showed that pregabalin may be cost-effective in the treatment of refractory NeP patients when compared with UC in routine medical practice in Spain.