The cost-effectiveness of pregabalin in the treatment of fibromyalgia: US perspective

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 150mg twice a day (BID) and pregabalin 225mg BID to placebo, 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 ≥30% 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 150mg BID than placebo, whereas pregabalin 225mg 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 225mg BID became cost saving and pregabalin 150mg 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. © 2012 Informa UK Ltd All rights reserved.