Pregabalin and gabapentin in matched patients with peripheral neuropathic pain in routine medical practice in a primary care setting: Findings from a cost-consequences analysis in a nested case-control study

Pérez, Concepción; Navarro, Ana; Saldaña, María T.; Masramon, Xavier; Rejas, Javier

doi:10.1016/j.clinthera.2010.07.014

Cited by 40 publications

(32 citation statements)

References 46 publications

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“…However, it should be noted that without appropriate standardization of patient characteristics, as well as in the number and extent of the variables studied, the results obtained should be interpreted with caution, and care should be taken in the external validation of the results. The results observed in our retrospective study are consistent with those of other series published in the Spanish health care setting, although before loss of data exclusivity occurred for both medicines 31, 32. A study by Perez et al 31 with a prospective observational design conducted in a health care setting similar to ours reported similar results (lower resource use and costs associated with treatment with pregabalin).…”

Section: Discussionsupporting

confidence: 92%

“…The results observed in our retrospective study are consistent with those of other series published in the Spanish health care setting, although before loss of data exclusivity occurred for both medicines 31, 32. A study by Perez et al 31 with a prospective observational design conducted in a health care setting similar to ours reported similar results (lower resource use and costs associated with treatment with pregabalin). Such results were also observed by Navarro et al 32 in patients refractory to gabapentin who switched their treatment to pregabalin.…”

Section: Discussionsupporting

confidence: 92%

“…It is one of the series with the highest number of subjects studied, which should be interpreted as a study strength 31, 32, 33, 34, 35, 36. However, it should be noted that without appropriate standardization of patient characteristics, as well as in the number and extent of the variables studied, the results obtained should be interpreted with caution, and care should be taken in the external validation of the results.…”

Section: Discussionmentioning

confidence: 99%

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Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity

Sicras‐Mainar¹,

Rejas‐Gutiérrez

Pérez‐Páramo

et al. 2016

Evaluation Clinical Practice

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To analyze the effect of loss of exclusivity of data on the cost of treatment of peripheral neuropathic pain (PNP) with pregabalin or gabapentin in routine clinical practice. A retrospective observational study, with electronic medical records for patients enrolled at primary care centers managed by the health care provider Badalona Serveis Assistencials, who initiated treatment of PNP with pregabalin or gabapentin. The analysis used drugs and resources prices for year 2015. The 1163 electronic medical records (pregabalin; N = 764, gabapentin; N = 399) for patients (62.2% women) with a mean (standard deviation) age of 59.2 (14.7) years were analyzed. Treatment duration was slightly shorter with pregabalin than with gabapentin (5.2 vs 5.5 months; P = 0.124), with mean doses of 227.4 (178.6) mg and 900.0 (443.4) mg, respectively. The average study drug cost per patient was higher for pregabalin than for gabapentin; €214.6 (206.3) vs €157.4 (181.9), P < 0.001, although the cost of concomitant analgesic medication was lower; €176.5 (271.8) vs €306.7 (529.2), P < 0.001. The adjusted average total cost per patient was lower in those treated with pregabalin than in those treated with gabapentin; €2,413 (2119‐2708) vs €3201 (2806–3.597); P = 0.002, owing to significantly lower health care costs; €1307 (1247‐1367) vs €1538 (1458‐1618), P < 0.001, and also non‐health care costs; €1106 (819‐1393) vs €1663 (1279‐2048), P = 0.023, that was caused by a significantly lower use of concomitant medication, fewer medical visits to primary care, and fewer days of sick leave. After loss of exclusivity of both drugs, pregabalin continued to show lower health care and non‐health care costs than gabapentin in the treatment of PNP in routine clinical practice.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity

Sicras‐Mainar¹,

Rejas‐Gutiérrez

Pérez‐Páramo

et al. 2016

Evaluation Clinical Practice

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“…Also, we cannot rule out completely that patients who are treated with gabapentin under routine medical practice are difficult to be treated to higher dosages such as the one observed in randomized clinical trial with such drug. The results observed in our retrospective study are consistent with other series published in the scientific literature either in Spain [19,20], and elsewhere as well [21][22][23][24]. All of such references, irrespectively of the economic type of study (cohort observational trial, economic modeling or clinical trial) have shown that in different types of PNP, pregabalin therapy is normally associated with lower healthcare resources utilization and fewer days of sick leave in comparison with gabapentin leading to a lower economic impact to the National Health System budgets, which is relevant when health decision is taken on a routine basis.…”

Section: Discussionsupporting

confidence: 83%

Cost of treating peripheral neuropathic pain with pregabalin or gabapentin at therapeutic doses in routine practice

Sicras‐Mainar¹,

Rejas‐Gutiérrez

Pérez‐Páramo

et al. 2018

J. Comp. Eff. Res.

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Aim:To analyze the cost of peripheral neuropathic pain (PNP) treatment with pregabalin or gabapentin at therapeutic doses in routine clinical practice. Methods: Analysis of a retrospective, observational study of electronic medical records of patients treated for PNP with therapeutic doses of pregabalin or gabapentin, with 2 years' follow-up, considering PNP type, comorbidities, concomitant analgesia and resource use. Results: The weighted total average cost/patient was lower for pregabalin than gabapentin (€2464 vs €3142 [2670-3614]; p = 0.014) due to significantly lower both healthcare and non-healthcare costs. This is explained by a significantly lower use of concomitant analgesia, fewer primary care visits and fewer days of sick leave. Conclusion: At therapeutic doses, pregabalin was found to have lower healthcare and non-healthcare costs than gabapentin in routine practice.

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“…Gabapentinoids benefit neuropathic cancer pain but may also reduce visceral and bone pain. Several studies involving treatment of neuropathic cancer pain found gabapentin to be the most commonly prescribed adjuvant [24, [66][67][68][69][70][71]. Gabapentin is also effective in a multitude of other symptoms including insomnia [72][73][74], cough [75][76][77], hiccough [78][79][80], nausea [81][82][83], and delirium [84].…”

Section: Discussionmentioning

confidence: 99%

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

Shinde

Gordon

Sharma

et al. 2014

Support Care Cancer

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Background Cancer pain is complex, and despite the introduction of the WHO cancer pain ladder, few studies have looked at the prevalence of adjuvant medication use in an inpatient palliative medicine unit. In this study, we evaluate the use of adjuvant pain medications in patients admitted to an inpatient palliative care unit and whether their use affects pain scores or opiate dosing. Methods In this retrospective observational study, patients admitted to the inpatient palliative care unit over a 3-month period with a diagnosis of cancer on opioid therapy were selected. Data pertaining to demographics, diagnosis, oral morphine dose equivalent of the opioid at the time of discharge, adjuvant analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and pain scores as reported by nurses and physicians were collected. Results Seventy-seven patients were eligible over a 3-month period, out of which 65 (84 %) were taking an adjuvant medication. The most commonly prescribed adjuvant was gabapentin (70 %). Fifty-seven percent were taking more than one adjuvant. There were more women in the group receiving adjuvants (57 vs. 17%, p=0.010). Those without adjuvants compared with those on adjuvants did not have worse pain scores on discharge as reported by physicians (0.8±0.8 vs. 1.0±0.7, p=0.58) or nurses (2.0±2.7 vs. 2.1±2.6, p=0.86). There was no difference in morphine equivalent doses of the opioid in both groups (median (min, max); 112 (58, 504) vs. 200 (30, 5,040)) at the time of discharge; 75-80 % of patients had improvement in pain scores as measured by a two-point reduction in numerical rating scale (NRS). Discussion This study shows that adjuvant medications are commonly used for treating pain in patients with cancer. More than half of study population were on two adjuvants or an adjuvant plus NSAID along with an opioid. We did not demonstrate any benefit in terms of improved pain scores or opioid doses with adjuvants, but this could reflect confounding variables and physician choice. Larger prospective studies are needed to define the opioid-sparing effects of adjuvants. Conclusion Adjuvant agents are used in over 80 % of those treated for cancer pain.

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Pregabalin and gabapentin in matched patients with peripheral neuropathic pain in routine medical practice in a primary care setting: Findings from a cost-consequences analysis in a nested case-control study

Cited by 40 publications

References 46 publications

Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity

Cost of treatment of peripheral neuropathic pain with pregabalin or gabapentin in routine clinical practice: impact of their loss of exclusivity

Cost of treating peripheral neuropathic pain with pregabalin or gabapentin at therapeutic doses in routine practice

Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?

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