A Systematic Review of Economic Evaluation Studies of Drug-Based Non-Malignant Chronic Pain Treatment

Curr Pharm Biotechnol. 2019;20(11):910-919. doi: 10.2174/1389201020666190717095443.


Background and objective: Chronic pain is a highly prevalent problem, involving high costs and seriously affecting a patient's quality of life. This review aimed to systematically review economic evaluations of pharmacological-based treatments for non-malignant chronic pain and to compare different treatment approaches with regard to their economic profile.

Methods: PubMed and Scopus were systematically searched in April 2016. Studies were included if quality-adjusted life years and incremental cost-effectiveness ratios were reported. Quality assessment was carried out by using La Torre's weighted scale on the Drummond checklist. Costs were converted into US$2014.

Results: Fourteen economic evaluations met the inclusion criteria. Three treatment categories identified were: opioids, anticonvulsants, and anti-depressants. Compared to anticonvulsants and antidepressant, opioids had lower ICER. Transdermal buprenorphine showed an ICER of about US$11,000.00 while pregabalin showed an ICER of US$19,200. Studies included showed a diversity of methodological approaches, such as different modeling approaches and different perspectives (NHS and private payer).

Conclusion: There are limitations to the success of making appropriate recommendations about which treatment is most cost-effective due to considerable variability between treatments, pain syndromes, and drug dosages. Opioids may have lower ICER, but the societal implications of the opioid epidemic and overdose deaths should be taken into account when coming to general conclusions about their cost-effectiveness. To ensure correct resource allocation as well as the best benefit for patients, uniform and standardized approaches of cost and outcome measurement in economic evaluations of chronic are needed.

Keywords: Chronic Pain; cost-effectiveness; economic evaluation; non-opioids; opioids..

Publication types

  • Systematic Review

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / economics*
  • Analgesics, Opioid / therapeutic use
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / economics*
  • Antidepressive Agents / therapeutic use
  • Chronic Pain / drug therapy*
  • Chronic Pain / economics
  • Cost-Benefit Analysis
  • Drug Overdose
  • Humans
  • Quality of Life


  • Analgesics, Opioid
  • Antidepressive Agents