A Cost-Effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia
OBJECTIVES: To compare the net health effects and costs resulting from treatment with different first‐line postherpetic neuralgia (PHN) medications. DESIGN: Cost–utility analysis using published literature. PARTICIPANTS: Hypothetical cohort of patients aged 60 to 80 with PHN. INTERVENTIONS: Desipram...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2007-08, Vol.55 (8), p.1176-1184 |
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| creator | O'Connor, Alec B. Noyes, Katia Holloway, Robert G. |
| description | OBJECTIVES: To compare the net health effects and costs resulting from treatment with different first‐line postherpetic neuralgia (PHN) medications.
DESIGN: Cost–utility analysis using published literature.
PARTICIPANTS: Hypothetical cohort of patients aged 60 to 80 with PHN.
INTERVENTIONS: Desipramine 100 mg/d, gabapentin 1,800 mg/d, and pregabalin 450 mg/d.
MEASUREMENTS: A decision model was designed to describe possible treatment outcomes, including different combinations of analgesia and side effects, during the first 3 months of therapy for moderate to severe PHN. The main outcome was cost per quality‐adjusted life‐year (QALY) gained. Costs were estimated using the perspective of a third‐party payer. Multivariate, univariate, and probabilistic sensitivity analyses were performed, and the time frame of the model was varied to 1‐month and 6‐month horizons.
RESULTS: Desipramine was more effective and less expensive than gabapentin or pregabalin (dominant) under all conditions tested. Gabapentin was more effective than pregabalin but at an incremental cost of $216,000/QALY. Below $140/month, gabapentin became more cost‐effective than pregabalin at a threshold of $50,000/QALY, and below $115/month gabapentin dominated pregabalin.
CONCLUSION: Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost‐effective than pregabalin. |
| doi_str_mv | 10.1111/j.1532-5415.2007.01246.x |
| format | Article |
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DESIGN: Cost–utility analysis using published literature.
PARTICIPANTS: Hypothetical cohort of patients aged 60 to 80 with PHN.
INTERVENTIONS: Desipramine 100 mg/d, gabapentin 1,800 mg/d, and pregabalin 450 mg/d.
MEASUREMENTS: A decision model was designed to describe possible treatment outcomes, including different combinations of analgesia and side effects, during the first 3 months of therapy for moderate to severe PHN. The main outcome was cost per quality‐adjusted life‐year (QALY) gained. Costs were estimated using the perspective of a third‐party payer. Multivariate, univariate, and probabilistic sensitivity analyses were performed, and the time frame of the model was varied to 1‐month and 6‐month horizons.
RESULTS: Desipramine was more effective and less expensive than gabapentin or pregabalin (dominant) under all conditions tested. Gabapentin was more effective than pregabalin but at an incremental cost of $216,000/QALY. Below $140/month, gabapentin became more cost‐effective than pregabalin at a threshold of $50,000/QALY, and below $115/month gabapentin dominated pregabalin.
CONCLUSION: Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost‐effective than pregabalin.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.2007.01246.x</identifier><identifier>PMID: 17661955</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Aged ; Amines - economics ; Amines - therapeutic use ; Analgesics - economics ; Analgesics - therapeutic use ; Antidepressive Agents, Tricyclic - economics ; Antidepressive Agents, Tricyclic - therapeutic use ; Biological and medical sciences ; Comparative studies ; Cost analysis ; Cost-Benefit Analysis ; cost-effectiveness ; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction ; Cyclohexanecarboxylic Acids - economics ; Cyclohexanecarboxylic Acids - therapeutic use ; desipramine ; Desipramine - economics ; Desipramine - therapeutic use ; Drug therapy ; gabapentin ; gamma-Aminobutyric Acid - analogs & derivatives ; gamma-Aminobutyric Acid - economics ; gamma-Aminobutyric Acid - therapeutic use ; General aspects ; Geriatrics ; Health care expenditures ; Herpes viruses ; Human viral diseases ; Humans ; Infectious diseases ; Medical sciences ; Medical treatment ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neuralgia, Postherpetic - drug therapy ; Neuralgia, Postherpetic - economics ; Neurology ; Older people ; postherpetic neuralgia ; Pregabalin ; Randomized Controlled Trials as Topic ; Severity of Illness Index ; Viral diseases ; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2007-08, Vol.55 (8), p.1176-1184</ispartof><rights>2007 INIST-CNRS</rights><rights>2007, The American Geriatrics Society</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4876-3f199a539e2f83a12f318cfe59b72f4998d603eda191d7b39ffbee0dcb2469643</citedby><cites>FETCH-LOGICAL-c4876-3f199a539e2f83a12f318cfe59b72f4998d603eda191d7b39ffbee0dcb2469643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1532-5415.2007.01246.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1532-5415.2007.01246.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18972793$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17661955$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O'Connor, Alec B.</creatorcontrib><creatorcontrib>Noyes, Katia</creatorcontrib><creatorcontrib>Holloway, Robert G.</creatorcontrib><title>A Cost-Effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>OBJECTIVES: To compare the net health effects and costs resulting from treatment with different first‐line postherpetic neuralgia (PHN) medications.
DESIGN: Cost–utility analysis using published literature.
PARTICIPANTS: Hypothetical cohort of patients aged 60 to 80 with PHN.
INTERVENTIONS: Desipramine 100 mg/d, gabapentin 1,800 mg/d, and pregabalin 450 mg/d.
MEASUREMENTS: A decision model was designed to describe possible treatment outcomes, including different combinations of analgesia and side effects, during the first 3 months of therapy for moderate to severe PHN. The main outcome was cost per quality‐adjusted life‐year (QALY) gained. Costs were estimated using the perspective of a third‐party payer. Multivariate, univariate, and probabilistic sensitivity analyses were performed, and the time frame of the model was varied to 1‐month and 6‐month horizons.
RESULTS: Desipramine was more effective and less expensive than gabapentin or pregabalin (dominant) under all conditions tested. Gabapentin was more effective than pregabalin but at an incremental cost of $216,000/QALY. Below $140/month, gabapentin became more cost‐effective than pregabalin at a threshold of $50,000/QALY, and below $115/month gabapentin dominated pregabalin.
CONCLUSION: Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost‐effective than pregabalin.</description><subject>Aged</subject><subject>Amines - economics</subject><subject>Amines - therapeutic use</subject><subject>Analgesics - economics</subject><subject>Analgesics - therapeutic use</subject><subject>Antidepressive Agents, Tricyclic - economics</subject><subject>Antidepressive Agents, Tricyclic - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Comparative studies</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>cost-effectiveness</subject><subject>Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction</subject><subject>Cyclohexanecarboxylic Acids - economics</subject><subject>Cyclohexanecarboxylic Acids - therapeutic use</subject><subject>desipramine</subject><subject>Desipramine - economics</subject><subject>Desipramine - therapeutic use</subject><subject>Drug therapy</subject><subject>gabapentin</subject><subject>gamma-Aminobutyric Acid - analogs & derivatives</subject><subject>gamma-Aminobutyric Acid - economics</subject><subject>gamma-Aminobutyric Acid - therapeutic use</subject><subject>General aspects</subject><subject>Geriatrics</subject><subject>Health care expenditures</subject><subject>Herpes viruses</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neuralgia, Postherpetic - drug therapy</subject><subject>Neuralgia, Postherpetic - economics</subject><subject>Neurology</subject><subject>Older people</subject><subject>postherpetic neuralgia</subject><subject>Pregabalin</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Severity of Illness Index</subject><subject>Viral diseases</subject><subject>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU9v1DAQxSMEokvhKyALiZ6aYMeJ_xw4VNuygKqyoovgZjnJePGSOMFOYPvtcdhVK3HCl7Fmfu9pNC9JEMEZie_NLiMlzdOyIGWWY8wzTPKCZftHyeJ-8DhZYIzzVDBSnCTPQtjhSGEhniYnhDNGZFkuEneBln0Y0ytjoB7tL3AQQmx1g_Y29A71Bl1CsIPXnXVwjla60gO40bpzpF2D1h62sdVah0zv0caDjrMtWkfX7-AHGG2NbmDyut1a_Tx5YnQb4MWxniZf3l1tlu_T60-rD8uL67QuBGcpNURKXVIJuRFUk9xQImoDpax4bgopRcMwhUYTSRpeUWlMBYCbuopnkKygp8nZwXfw_c8Jwqg6G2poW-2gn4JiguCckBl89Q-46yfv4m4qJ5hyysoZEgeo9n0IHowavO20v1MEqzkQtVPz3dV8dzUHov4GovZR-vLoP1UdNA_CYwIReH0EdKh1a7x2tQ0PnJA855JG7u2B-21buPvvBdTH1e38i_r0oLdhhP29XvsfinHKS_X1ZqXI59vNt0u2Vpz-AeIftYo</recordid><startdate>200708</startdate><enddate>200708</enddate><creator>O'Connor, Alec B.</creator><creator>Noyes, Katia</creator><creator>Holloway, Robert G.</creator><general>Blackwell Publishing Inc</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>200708</creationdate><title>A Cost-Effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia</title><author>O'Connor, Alec B. ; Noyes, Katia ; Holloway, Robert G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4876-3f199a539e2f83a12f318cfe59b72f4998d603eda191d7b39ffbee0dcb2469643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Amines - economics</topic><topic>Amines - therapeutic use</topic><topic>Analgesics - economics</topic><topic>Analgesics - therapeutic use</topic><topic>Antidepressive Agents, Tricyclic - economics</topic><topic>Antidepressive Agents, Tricyclic - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Comparative studies</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>cost-effectiveness</topic><topic>Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction</topic><topic>Cyclohexanecarboxylic Acids - economics</topic><topic>Cyclohexanecarboxylic Acids - therapeutic use</topic><topic>desipramine</topic><topic>Desipramine - economics</topic><topic>Desipramine - therapeutic use</topic><topic>Drug therapy</topic><topic>gabapentin</topic><topic>gamma-Aminobutyric Acid - analogs & derivatives</topic><topic>gamma-Aminobutyric Acid - economics</topic><topic>gamma-Aminobutyric Acid - therapeutic use</topic><topic>General aspects</topic><topic>Geriatrics</topic><topic>Health care expenditures</topic><topic>Herpes viruses</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Medical sciences</topic><topic>Medical treatment</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neuralgia, Postherpetic - drug therapy</topic><topic>Neuralgia, Postherpetic - economics</topic><topic>Neurology</topic><topic>Older people</topic><topic>postherpetic neuralgia</topic><topic>Pregabalin</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Severity of Illness Index</topic><topic>Viral diseases</topic><topic>Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>O'Connor, Alec B.</creatorcontrib><creatorcontrib>Noyes, Katia</creatorcontrib><creatorcontrib>Holloway, Robert G.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>O'Connor, Alec B.</au><au>Noyes, Katia</au><au>Holloway, Robert G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Cost-Effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2007-08</date><risdate>2007</risdate><volume>55</volume><issue>8</issue><spage>1176</spage><epage>1184</epage><pages>1176-1184</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>OBJECTIVES: To compare the net health effects and costs resulting from treatment with different first‐line postherpetic neuralgia (PHN) medications.
DESIGN: Cost–utility analysis using published literature.
PARTICIPANTS: Hypothetical cohort of patients aged 60 to 80 with PHN.
INTERVENTIONS: Desipramine 100 mg/d, gabapentin 1,800 mg/d, and pregabalin 450 mg/d.
MEASUREMENTS: A decision model was designed to describe possible treatment outcomes, including different combinations of analgesia and side effects, during the first 3 months of therapy for moderate to severe PHN. The main outcome was cost per quality‐adjusted life‐year (QALY) gained. Costs were estimated using the perspective of a third‐party payer. Multivariate, univariate, and probabilistic sensitivity analyses were performed, and the time frame of the model was varied to 1‐month and 6‐month horizons.
RESULTS: Desipramine was more effective and less expensive than gabapentin or pregabalin (dominant) under all conditions tested. Gabapentin was more effective than pregabalin but at an incremental cost of $216,000/QALY. Below $140/month, gabapentin became more cost‐effective than pregabalin at a threshold of $50,000/QALY, and below $115/month gabapentin dominated pregabalin.
CONCLUSION: Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost‐effective than pregabalin.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>17661955</pmid><doi>10.1111/j.1532-5415.2007.01246.x</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Amines - economics Amines - therapeutic use Analgesics - economics Analgesics - therapeutic use Antidepressive Agents, Tricyclic - economics Antidepressive Agents, Tricyclic - therapeutic use Biological and medical sciences Comparative studies Cost analysis Cost-Benefit Analysis cost-effectiveness Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction Cyclohexanecarboxylic Acids - economics Cyclohexanecarboxylic Acids - therapeutic use desipramine Desipramine - economics Desipramine - therapeutic use Drug therapy gabapentin gamma-Aminobutyric Acid - analogs & derivatives gamma-Aminobutyric Acid - economics gamma-Aminobutyric Acid - therapeutic use General aspects Geriatrics Health care expenditures Herpes viruses Human viral diseases Humans Infectious diseases Medical sciences Medical treatment Middle Aged Nervous system (semeiology, syndromes) Neuralgia, Postherpetic - drug therapy Neuralgia, Postherpetic - economics Neurology Older people postherpetic neuralgia Pregabalin Randomized Controlled Trials as Topic Severity of Illness Index Viral diseases Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye |
| title | A Cost-Effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia |
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