Abstract
The purpose of this study was to compare the cost-effectiveness of duloxetine versus
routine treatment in management of diabetic peripheral neuropathic pain (DPNP). Two
hundred thirty-three patients with DPNP who completed a 12-week, double-blind, placebo-controlled,
randomized, multicenter duloxetine trial were re-randomized into a 52-week, open-label
trial of duloxetine 60 mg twice daily versus routine treatment. Routine treatment
included pain management therapies. Effectiveness was measured by using the bodily
pain domain (BP) of the Medical Outcomes Study Short Form 36 (SF-36). Costs were analyzed
from 3 perspectives: third party payer (direct medical costs), employer (direct and
indirect medical costs), and societal (patient’s out-of-pocket costs and total medical
costs). Costs of study medications were not included because of limited data. Bootstrap
method was applied to calculate statistical inference of the incremental cost-effectiveness
ratio (ICER). Routine treatment most frequently used included gabapentin (56%), venlafaxine
(36%), and amitripytline (15%). From employer and societal perspectives, duloxetine
was cost-effective (ICER= –$342 and –$429, respectively, per unit of SF-36 BP; both
P ≤ .03) and the dominant therapy compared with routine DPNP treatment (both P < .05). From payer perspective, duloxetine trended toward cost-effectiveness (ICER=
–$249 per unit of SF-36 BP; P ≤ .06). These results, however, reflect the controlled environment of a clinical
trial. An analysis of real-world data would be beneficial.
Perspective
Evaluation of the cost and benefit of new pharmacologic treatments is highly desired
by decision makers. From both employer perspective and societal perspective (including
patient’s out-of-pocket costs), this study demonstrated that duloxetine was more cost-effective
than routine treatment in management of DPNP.
Key words
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Article info
Publication history
Accepted:
January 3,
2006
Received in revised form:
December 10,
2005
Received:
July 12,
2005
Footnotes
Supported by research contract through Eli Lilly and Company.
Identification
Copyright
© 2006 American Pain Society. Published by Elsevier Inc. All rights reserved.
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- Letter to the EditorThe Journal of PainVol. 7Issue 11
- PreviewThe article entitled “Cost-Effectiveness of Duloxetine Versus Routine Treatment for U.S. Patients With Diabetic Peripheral Neuropathic Pain”4 is misleading. The authors conclude that duloxetine is cost-effective, but they have not accurately quantified the costs of care because they have not considered the cost of duloxetine or the alternatives used in “routine care.” The authors state that drug costs were excluded because “the study arms were not designed for direct drug cost comparisons” and “complete information on the dosage and length of therapy for the routine care group was not obtained for cost calculations.” Since medication costs represent a large proportion of the cost of care of these patients, the authors do not have sufficient data to perform a meaningful cost-effectiveness analysis.
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