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A cost-consequences analysis of the effect of pregabalin in the treatment of peripheral neuropathic pain in routine medical practice in primary care settings.

Navarro A, Saldaña MT, Pérez C, Torrades S, Rejas J - BMC Neurol (2011)

Bottom Line: One-thousand-three-hundred-fifty-four PGB-naive patients [58.8% women, 59.5 (12.7) years old] were found eligible for this secondary analysis: 598 (44%) switched from previous therapy to PGB given in monotherapy (PGBm), 589 (44%) received PGB as add-on therapy (PGB add-on), and 167 (12%) patients changed previous treatments to others different than PGB (non-PGB).Incremental drug costs, particularly in PGB subgroups [€ 34.6 (80.3), € 160.7 (123.9) and € 154.5 (133.0), for non-PGB, PGBm and PGBadd-on, respectively (p < 0.001)], were off-set by higher significant reductions in all other components of health costs yielding to a greater total cost reductions: -€ 1,045.3 (1,989.6),-€ 1,312.9 (1,543.0), and -€ 1,565.5 (2,004.1), for the three groups respectively (p = 0.03).In Spanish primary care settings, PGB given either add-on or in monotherapy in routine medical practice was associated with pain alleviation leading to significant longitudinal reductions in resource use and total costs during the 12-week period of the study compared with non-PGB-therapy of patients with chronic NeP of peripheral origin.

View Article: PubMed Central - HTML - PubMed

Affiliation: Primary Care Health Centre Puerta del Ángel, Madrid, Spain. navarrosiguero@eresmas.com

ABSTRACT

Background: Neuropathic pain (NeP) is a common symptom of a group of a variety of conditions, including diabetic neuropathy, trigeminal neuralgia, or postherpetic neuralgia. Prevalence of NeP has been estimated to range between 5-7.5%, and produces up to 25% of pain clinics consultations. Due to its severity, chronic evolution, and associated co-morbidities, NeP has an important individual and social impact. The objective was to analyze the effect of pregabalin (PGB) on pain alleviation and longitudinal health and non-health resources utilization and derived costs in peripheral refractory NeP in routine medical practice in primary care settings (PCS) in Spain.

Methods: Subjects from PCS were older than 18 years, with peripheral NeP (diabetic neuropathy, post-herpetic neuralgia or trigeminal neuralgia), refractory to at least one previous analgesic, and included in a prospective, real world, and 12-week two-visit cost-of-illness study. Measurement of resources utilization included both direct healthcare and indirect expenditures. Pain severity was measured by the Short Form-McGill Pain Questionnaire (SF-MPQ).

Results: One-thousand-three-hundred-fifty-four PGB-naive patients [58.8% women, 59.5 (12.7) years old] were found eligible for this secondary analysis: 598 (44%) switched from previous therapy to PGB given in monotherapy (PGBm), 589 (44%) received PGB as add-on therapy (PGB add-on), and 167 (12%) patients changed previous treatments to others different than PGB (non-PGB). Reductions of pain severity were higher in both PGBm and PGB add-on groups (54% and 51%, respectively) than in non-PGB group (34%), p < 0.001. Incremental drug costs, particularly in PGB subgroups [€ 34.6 (80.3), € 160.7 (123.9) and € 154.5 (133.0), for non-PGB, PGBm and PGBadd-on, respectively (p < 0.001)], were off-set by higher significant reductions in all other components of health costs yielding to a greater total cost reductions: -€ 1,045.3 (1,989.6),-€ 1,312.9 (1,543.0), and -€ 1,565.5 (2,004.1), for the three groups respectively (p = 0.03).

Conclusion: In Spanish primary care settings, PGB given either add-on or in monotherapy in routine medical practice was associated with pain alleviation leading to significant longitudinal reductions in resource use and total costs during the 12-week period of the study compared with non-PGB-therapy of patients with chronic NeP of peripheral origin. The use of non-appropriate analgesic therapies for neuropathic pain in a portion of subjects in non-PGB group could explain partially such findings.

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Weekly mean change in pain intensity according to the SF-MPQ VAS. VAS: Visual analogue scale; PGB: pregabalin; W1-W12: weeks 1 to 12; SF-MPQ: McGill Pain Questionnaire Short-Form. *p < 0.05, †p < 0.01, ‡p < 0.001 vs. Non-PGB group.
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Figure 2: Weekly mean change in pain intensity according to the SF-MPQ VAS. VAS: Visual analogue scale; PGB: pregabalin; W1-W12: weeks 1 to 12; SF-MPQ: McGill Pain Questionnaire Short-Form. *p < 0.05, †p < 0.01, ‡p < 0.001 vs. Non-PGB group.

Mentions: After adjusting for baseline scores, significant reductions in pain symptoms scores and intensity were observed in the three groups starting the first week of treatment (Figure 2), being this reduction significantly greater in both PGB groups compared to the non-PGB group, with mean changes of 54% and 51% for PGB monotherapy and add-on group, respectively, compared to 34% in the group not receiving PGB (p < 0.001). These significant differences were observed between the two PGB-treated groups and the non-PGB group from 5th/6th weeks of follow up, which continued to decrease smoothly across the study (Figure 2). At the end of the study, 57.9% and 52.1% of patients who received PGB monotherapy and PGB add-on, respectively, showed a 50% reduction of baseline pain intensity, compared to 30.2% in the non-PGB group (p < 0.001), resulting in a higher cumulative number of days with no or mild pain in the PGB groups compared to the group not receiving PGB; 35.0 (29.8), 29.8 (28.9) and 25.5 (29.4), respectively (p < 0.001).


A cost-consequences analysis of the effect of pregabalin in the treatment of peripheral neuropathic pain in routine medical practice in primary care settings.

Navarro A, Saldaña MT, Pérez C, Torrades S, Rejas J - BMC Neurol (2011)

Weekly mean change in pain intensity according to the SF-MPQ VAS. VAS: Visual analogue scale; PGB: pregabalin; W1-W12: weeks 1 to 12; SF-MPQ: McGill Pain Questionnaire Short-Form. *p < 0.05, †p < 0.01, ‡p < 0.001 vs. Non-PGB group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3037328&req=5

Figure 2: Weekly mean change in pain intensity according to the SF-MPQ VAS. VAS: Visual analogue scale; PGB: pregabalin; W1-W12: weeks 1 to 12; SF-MPQ: McGill Pain Questionnaire Short-Form. *p < 0.05, †p < 0.01, ‡p < 0.001 vs. Non-PGB group.
Mentions: After adjusting for baseline scores, significant reductions in pain symptoms scores and intensity were observed in the three groups starting the first week of treatment (Figure 2), being this reduction significantly greater in both PGB groups compared to the non-PGB group, with mean changes of 54% and 51% for PGB monotherapy and add-on group, respectively, compared to 34% in the group not receiving PGB (p < 0.001). These significant differences were observed between the two PGB-treated groups and the non-PGB group from 5th/6th weeks of follow up, which continued to decrease smoothly across the study (Figure 2). At the end of the study, 57.9% and 52.1% of patients who received PGB monotherapy and PGB add-on, respectively, showed a 50% reduction of baseline pain intensity, compared to 30.2% in the non-PGB group (p < 0.001), resulting in a higher cumulative number of days with no or mild pain in the PGB groups compared to the group not receiving PGB; 35.0 (29.8), 29.8 (28.9) and 25.5 (29.4), respectively (p < 0.001).

Bottom Line: One-thousand-three-hundred-fifty-four PGB-naive patients [58.8% women, 59.5 (12.7) years old] were found eligible for this secondary analysis: 598 (44%) switched from previous therapy to PGB given in monotherapy (PGBm), 589 (44%) received PGB as add-on therapy (PGB add-on), and 167 (12%) patients changed previous treatments to others different than PGB (non-PGB).Incremental drug costs, particularly in PGB subgroups [€ 34.6 (80.3), € 160.7 (123.9) and € 154.5 (133.0), for non-PGB, PGBm and PGBadd-on, respectively (p < 0.001)], were off-set by higher significant reductions in all other components of health costs yielding to a greater total cost reductions: -€ 1,045.3 (1,989.6),-€ 1,312.9 (1,543.0), and -€ 1,565.5 (2,004.1), for the three groups respectively (p = 0.03).In Spanish primary care settings, PGB given either add-on or in monotherapy in routine medical practice was associated with pain alleviation leading to significant longitudinal reductions in resource use and total costs during the 12-week period of the study compared with non-PGB-therapy of patients with chronic NeP of peripheral origin.

View Article: PubMed Central - HTML - PubMed

Affiliation: Primary Care Health Centre Puerta del Ángel, Madrid, Spain. navarrosiguero@eresmas.com

ABSTRACT

Background: Neuropathic pain (NeP) is a common symptom of a group of a variety of conditions, including diabetic neuropathy, trigeminal neuralgia, or postherpetic neuralgia. Prevalence of NeP has been estimated to range between 5-7.5%, and produces up to 25% of pain clinics consultations. Due to its severity, chronic evolution, and associated co-morbidities, NeP has an important individual and social impact. The objective was to analyze the effect of pregabalin (PGB) on pain alleviation and longitudinal health and non-health resources utilization and derived costs in peripheral refractory NeP in routine medical practice in primary care settings (PCS) in Spain.

Methods: Subjects from PCS were older than 18 years, with peripheral NeP (diabetic neuropathy, post-herpetic neuralgia or trigeminal neuralgia), refractory to at least one previous analgesic, and included in a prospective, real world, and 12-week two-visit cost-of-illness study. Measurement of resources utilization included both direct healthcare and indirect expenditures. Pain severity was measured by the Short Form-McGill Pain Questionnaire (SF-MPQ).

Results: One-thousand-three-hundred-fifty-four PGB-naive patients [58.8% women, 59.5 (12.7) years old] were found eligible for this secondary analysis: 598 (44%) switched from previous therapy to PGB given in monotherapy (PGBm), 589 (44%) received PGB as add-on therapy (PGB add-on), and 167 (12%) patients changed previous treatments to others different than PGB (non-PGB). Reductions of pain severity were higher in both PGBm and PGB add-on groups (54% and 51%, respectively) than in non-PGB group (34%), p < 0.001. Incremental drug costs, particularly in PGB subgroups [€ 34.6 (80.3), € 160.7 (123.9) and € 154.5 (133.0), for non-PGB, PGBm and PGBadd-on, respectively (p < 0.001)], were off-set by higher significant reductions in all other components of health costs yielding to a greater total cost reductions: -€ 1,045.3 (1,989.6),-€ 1,312.9 (1,543.0), and -€ 1,565.5 (2,004.1), for the three groups respectively (p = 0.03).

Conclusion: In Spanish primary care settings, PGB given either add-on or in monotherapy in routine medical practice was associated with pain alleviation leading to significant longitudinal reductions in resource use and total costs during the 12-week period of the study compared with non-PGB-therapy of patients with chronic NeP of peripheral origin. The use of non-appropriate analgesic therapies for neuropathic pain in a portion of subjects in non-PGB group could explain partially such findings.

Show MeSH
Related in: MedlinePlus