A Cost-Effectiveness Analysis Of Pregabalin For The Treatment Of Patients With Chronic Cervical Pain With A Neuropathic Component In Japan

Manabu Akazawa; Ataru Igarashi; Nozomi Ebata; Tatsunori Murata; Shigeki Zeniya; Yuri Haga; Kazutaka Nozawa; Koichi Fujii; Toshihiko Taguchi

doi:10.2147/JPR.S203712

A Cost-Effectiveness Analysis Of Pregabalin For The Treatment Of Patients With Chronic Cervical Pain With A Neuropathic Component In Japan

J Pain Res. 2019 Sep 23:12:2785-2797. doi: 10.2147/JPR.S203712. eCollection 2019.

Authors

Manabu Akazawa¹, Ataru Igarashi², Nozomi Ebata³, Tatsunori Murata⁴, Shigeki Zeniya⁴, Yuri Haga⁵, Kazutaka Nozawa³, Koichi Fujii³, Toshihiko Taguchi⁶

Affiliations

¹ Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan.
² Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.
³ Medical Affairs, Pfizer Japan Inc., Tokyo, Japan.
⁴ CRECON Medical Assessment Inc., Tokyo, Japan.
⁵ Clinical Research Division, Clinical Study Support, Inc., Nagoya, Japan.
⁶ Yamaguchi Rosai Hospital, Yamaguchi, Japan.

Abstract

Purpose: To evaluate the cost-effectiveness of pregabalin versus other analgesics among patients with chronic cervical pain with neuropathic components during routine clinical practice in Japan.

Patients and methods: The analysis considered patients with chronic cervical pain with a neuropathic pain component (radiating pain to the upper limb) and who were treated with pregabalin with or without other analgesics (pregabalin-containing treatments) or other analgesics alone (usual care) for 8 weeks. Other analgesics included non-steroidal anti-inflammatory drugs (NSAIDs), weak opioids, antidepressants, and antiepileptic drugs. A Markov cohort simulation model was constructed to estimate costs and effectiveness (in terms of quality-adjusted life-years, QALYs) of each treatment over a 12-month time horizon. In the model, patients transitioned among three states of pain severity (no/mild, moderate, and severe). Data were derived from a previous observational study (pregabalin-containing treatments, n = 138; usual care, n = 211). Cost inputs included medical costs and productivity losses. QALYs were calculated using the EuroQol five-dimensional, five-level questionnaire. The cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to assess the robustness of results.

Results: From the payer's perspective, pregabalin-containing treatments were more costly (JPY 61,779 versus JPY 26,428) but also more effective (0.763 QALYs versus 0.727 QALYs) than the usual care, with an ICER of JPY 970,314 per QALY gained. From the societal perspective, which also included productivity losses, the ICER reduced to JPY 458,307 per QALY gained. One-way sensitivity analyses demonstrated the robustness of the results. Given a hypothetical threshold value of one additional QALY of JPY 5,000,000, the probability of pregabalin-containing treatments being cost-effective was 100%.

Conclusion: Compared with using other analgesics alone, the use of pregabalin, alone or in addition to other analgesics, was cost-effective for the treatment of chronic cervical pain with a neuropathic pain component in Japan.

Keywords: health economics; incremental cost-effectiveness ratio; neuropathic pain; quality-adjusted life-year.