Cost-effectiveness analysis of pregabalin versus gabapentin in the management of neuropathic pain due to diabetic polyneuropathy or post-herpetic neuralgia

Objective: To estimate the cost-effectiveness of branded pregabalin (PGB) versus generic gabapentin (GBP) in patients with neuropathic pain (NeP) due to painful diabetic polyneuropathy (DPN) or post-herpetic neuralgia (PHN) in Spain. Methods: Using stochastic simulation, we estimated the cost-effectiveness of PGB 150600 mg/d vs. GBP 900-3600 mg/d in a hypothetical cohort of 1000 patients. The model used data from three randomized controlled clinical trials. Pain was evaluated using a 0-10 scale. Mean baseline pain was 6.9 in both treatment groups. The model assigned untreated pain scores over 84 days. Treated scores were calculated using weekly changes in pain scores from trials. Outcomes included the numbers of days with no or mild pain (score < 4), days with >= 30% and >= 50% reductions in pain intensity, quality-adjusted life-years (QALYs), and estimated health costs. Results: Compared with GBP, PGB yielded an estimated mean of 8 (standard error, 0-4) additional days with no or mild pain, 6 (0.4) days with >= 30% reduction in pain intensity, 9 (0.5) days with >= 50% reduction in pain intensity, and a gain of 0.1186 (0.0002) OALYs for 12 weeks. The estimated total health costs of therapies were (1049 (05) for PGB and (951 ((38) for GBP, respectively. Incremental cost-effectiveness ratio (ICER) for PGB versus GBP were a mean of epsilon 12 (95% confidence interval, epsilon 1-24) per additional day with no or mild pain, epsilon 431 (dominant-epsilon 876) per additional patient with no or mild pain, and epsilon 20535 (epsilon 1607-40345) per QALY gained. Conclusions: According with data used in this modeling in patients with NeP due to DPN and/or PHN, PGB was shown to be more cost-effective than generic gabapentin in Spain.