A systematic review of cost-effectiveness modeling of pharmaceutical therapies in neuropathic pain: variation in practice, key challenges, and recommendations for the future

Abstract

Objectives: Complexities in the neuropathic-pain care pathway make the condition difficult to manage and difficult to capture in cost-effectiveness models. The aim of this study is to understand, through a systematic review of previous cost-effectiveness studies, some of the key strengths and limitations in data and modeling practices in neuropathic pain. Thus, the aim is to guide future research and practice to improve resource allocation decisions and encourage continued investment to find novel and effective treatments for patients with neuropathic pain. Methods: The search strategy was designed to identify peer-reviewed cost-effectiveness evaluations of non-surgical, pharmaceutical therapies for neuropathic pain published since January 2000, accessing five key databases. All identified publications were reviewed and screened according to pre-defined eligibility criteria. Data extraction was designed to reflect key data challenges and approaches to modeling in neuropathic pain and based on published guidelines. Results: The search strategy identified 20 cost-effectiveness analyses meeting the inclusion criteria, of which 14 had original model structures. Cost-effectiveness modeling in neuropathic pain is established and increasing across multiple jurisdictions; however, amongst these studies, there is substantial variation in modeling approach, and there are common limitations. Capturing the effect of treatments upon health outcomes, particularly health-related quality-of-life, is challenging, and the health effects of multiple lines of ineffective treatment, common for patients with neuropathic pain, have not been consistently or robustly modeled. Conclusions: To improve future economic modeling in neuropathic pain, further research is suggested into the effect of multiple lines of treatment and treatment failure upon patient outcomes and subsequent treatment effectiveness; the impact of treatment-emergent adverse events upon patient outcomes; and consistent and appropriate pain measures to inform models. The authors further encourage transparent reporting of inputs used to inform cost-effectiveness models, with robust, comprehensive and clear uncertainty analysis and, where feasible, open-source modeling is encouraged. ARTICLE HISTORY

Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain

“…Indirect costs are generally not considered in health technology assessment 69 - 71 . In addition, based on the Affordable Care Act (ACA), cost effectiveness is not utilized as a basis for coverage or other analysis in the US 70 - 74 .…”

“…Multiple advantages of this study include the data derived from an RCT of 120 patients 54 , 55 making it the first and only cost utility analysis from an RCT. In addition, it has been recommended that cost effectiveness models should make use of data on absolute pain including baseline pain, routinely collected in trials, to inform model health-related quality of life outcomes 69 . Critchlow et al 69 strongly recommended that absolute pain categories from 11-point NRS data are used to capture key pain outcomes.…”

Comparative analyses of published cost effectiveness models highlight critical considerations which are useful to inform development of new models

“…Comparisons of cost effectiveness models are frequently undertaken and published [1][2][3][4][5][6][7] to assess quality, bias 8 and transferability of results 9,10 . When developing a new cost-effectiveness model, it is important to investigate and compare previous models to gain insight into analytical approaches, model assumptions and natural history of disease, which remain relevant over time 11,12 .…”

Cost-effectiveness modeling for neuropathic pain treatments: investigating the relative importance of parameters using an open-source model

“…There are, however, challenges in the health economic modeling of a heterogeneous disease area such as neuropathic pain [10,12]. According to Critchlow et al [12], the only published HTA model for cost-effectiveness analysis of pharmacological treatment of neuropathic pain which is reported in a replicable and reliable format is a model developed by NICE to inform its clinical guideline recommendations [6]. The NICE model allowed for "comparison of the maximum number of drugs for which data are available in a transparent way" taking into consideration "the potentially serious limitations found in previous economic models of pharmacological treatments for neuropathic pain".…”

“…The NICE model allowed for "comparison of the maximum number of drugs for which data are available in a transparent way" taking into consideration "the potentially serious limitations found in previous economic models of pharmacological treatments for neuropathic pain". Critchlow et al [12] also suggest that in order to encourage further transparency beyond the NICE model, future developers should report data inputs used to inform cost-effectiveness models, provide a clear description of the analysis of uncertainty and (if possible) produce an open-source model. The need for transparency in the health economic modeling of medicines has been discussed with increasing interest over the last decade, with the aim of promoting 'trustworthy, reproducible, validated, comparable and flexible health economic models which could lead to better decisions in healthcare' [13,14,15].…”