The effectiveness and cost-effectiveness of pregabalin in the treatment of diabetic peripheral neuropathy: A systematic review and economic model

Abstract

The Diabetic Peripheral Neuropathy (DPN) is the most common complication in diabetic patients which is accompanied with substantial economic burden regarding the productivity loss and medical therapy. In this study, we analyzed the cost efficacy of pregabalin for treatment of diabetic neuropathic pain in Iran. To evaluate the efficacy of pregabalin, we conducted a systematic review of published articles by searching on PubMed, Scopus and Google scholar. The keywords were: "pregabalin", "neuropathic pain", "diabetic peripheral neuropathy". The "mean pain score" and also "percentage of patients with more than 50% pain reduction" were the outcome of interest for evaluation of efficacy of drug in peripheral neuropathic pain. For calculation of cost, only direct medical costs were evaluated. The Incremental Cost Effectiveness Ratio (ICER) was compared with one and three times of Gross Domestic Product (GDP) per capita as threshold to evaluate if the treatment is "highly cost effective", "cost effective" and "not cost effective". Out of 8476 evaluated papers, finally five articles were included in the study which met our inclusion criteria. All of these reports were Randomized Controlled Trial (RCT) of the comparison of pregabalin with placebo. Considering the efficacy extracted from the reports, pregabalin 75 and 150 mg day -1 did not have any significant efficacy in comparison with placebo. In pregabalin 300 mg day -1, the ICER range for generic and brand pregabalin were 6-200 and 63-2059, respectively. Accordingly, for generic and brand pregabalin (600 mg day -1), they were 11-755 and 78-5333 US Dollars (USD) per one more score reduction in mean pain score compared with placebo that could be seen as highly cost effective treatment. Our analysis indicated that pregabalin (300 mg day -1 or 600 mg day -1) is highly cost effective treatments in both generic and brand forms. Considering the same efficacy of generic and brand pregabalin, it seems more rational to include generic pregabalin in positive list of reimbursement, although both of them are cost effective. © 2012 Asian Network for Scientific Information.