IngentaConnect Cost effectiveness of duloxetine in the treatment of diabetic per...

Authors: Beard, S.M.¹; McCrink, L.¹; Le, T.K.²; Garcia-Cebrian, A.³; Monz, B.⁴; Malik, R.A.⁵

Source: Current Medical Research and Opinion, Volume 24, Number 2, February 2008 , pp. 385-399(15)

Abstract:

Objective: The objective of this analysis was to evaluate the cost-effectiveness of duloxetine when considered as an additional treatment option for UK-based patients suffering from diabetic peripheral neuropathic pain.

Research design and methods: A decision-analytic model was used to represent the sequential management of patients with diabetic peripheral neuropathic pain. The standard UK treatment strategy was defined as first-line tricyclic antidepressants (amitriptyline), second-line anticonvulsants (gabapentin) and lastly an opioid-related treatment. The cost-effectiveness of duloxetine was evaluated as an additional first, second, third or fourth-line therapy over a 6-month treatment period for a cohort of 1000 patients. Treatment response was modelled based on changes from baseline pain severity using a standard 11-point pain scale (0-10); full response (≥ 50% change), partial response (30-49%) and no response (< 30%). The model was populated with efficacy and discontinuation data using indirect comparisons of treatment efficacy based on relative effects to a common placebo comparator.

Results: The second-line use of duloxetine resulted in cost savings of £77 071 for every 1000 treated patients, with an additional 29 patients achieving a full pain response when compared to standard UK treatment. Additional quality-adjusted life years (QALYs) were achieved at 1.88 QALYs per 1000 patients.

Conclusions: This UK-based economic model suggests that second-line use of duloxetine is a beneficial and cost-effective treatment strategy for diabetic peripheral neuropathic pain.

Keywords: COST-EFFECTIVENESS; DIABETES; DULOXETINE; ECONOMIC EVALUATION; NEUROPATHIC PAIN

Document Type: Research article

DOI: 10.1185/030079908X253852

Affiliations: 1: RTI Health Solutions, Manchester, UK 2: Eli Lilly and Company, Indianapolis, IN, USA 3: Eli Lilly and Company Limited, Windlesham, Surrey, UK 4: Boehringer Ingelheim GmbH, Ingelheim, Germany 5: Academic Department of Medicine, Manchester Royal Infirmary, Manchester, UK

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Cost effectiveness of duloxetine in the treatment of diabetic peripheral neuropathic pain in the UK