Economic evaluation of duloxetine as a first-line treatment for painful diabetic peripheral neuropathy in Mexico

Abstract

This study suggests that DUL provides overall savings and better health outcomes compared with branded-GBP and PGB. Administering DUL rather than generic-GBP is a cost-effective intervention to manage PDPN in Mexico.

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

“…The search identified 797 studies, 20 of which met the inclusion criteria. Of the 20 included studies, 14 presented original model structures 4,5,[16][17][18][19][20][21][22][23][24]27,29,30 , and six used existing model structures populated with data and assumptions that differed from those in the original study 3,25,26,[31][32][33] . Herein, where data and scope are compared, we refer to all 20 included studies, but where model type and structural elements are compared, we compare across the 14 original model structures only.…”

“…Results in Table 1 suggest that the volume of cost-effectiveness studies in neuropathic pain is increasing; over 50% of the 20 inclusions (11 studies) were published after January 2010 [3][4][5]17,19,20,25,29,[31][32][33] . This may reflect an emergence of new treatments for neuropathic pain, and an increasing need across jurisdictions to demonstrate cost-effectiveness in order to receive reimbursement for these types of therapies.…”

“…The second most widely appraised therapy was gabapentin, used in five European studies 5,24,26,30,31 . Seven studies were conducted in North America 17,19,20,22,23,27,30 , where appraisal of pregabalin and gabapentin was common across cost-effectiveness analyses and over time 17,19,20,22,23,27,30 . Duloxetine has been appraised in two North American studies published since 2011 17,20 .…”

“…Two further applications of one model structure used mapping 42 to link utility estimates to pain data within their analyses 4,33 . The vast majority of the studies in this review used estimates from another study to inform utility assumptions in their analyses 5,[16][17][18][19][20][21][22][23][24][25][26][27]30,32 . The validity of such an approach depends on the quality and relevance of the other study; inferred differences in utility across treatment comparisons could be confounded by differences in patient characteristics, treatments and overall experiences across the target patient group, and the source of utility data.…”

“…These complexities include: patient and treatment heterogeneity; challenges in understanding how treatments affect health outcomes, in particular HRQoL; and understanding the HRQoL and cost implications of multiple, consecutive lines of often ineffective treatment. In 2013, the National Institute for Health and Care Excellence (NICE) in England and Wales reviewed previous economic analyses in neuropathic pain to inform guidance on pharmacological management of neuropathic pain 5 , and were critical of 'potentially serious limitations' in each of the 13 studies identified 4,[16][17][18][19][20][21][22][23][24][25][26][27] . However, the NICE reviewers were not specific in their criticism 5 .…”