Cost-effectiveness of ziconotide in intrathecal pain management for severe chronic pain patients in the UK

ABSTRACT

Objective: To examine the cost-effectiveness of using intrathecal ziconotide in the treatment of severe chronic pain compared to best supportive care for patients with intractable chronic pain in the United Kingdom.

Methods: Using a simulation model, the analysis evaluated the cost and health economic consequences of using ziconotide as a treatment for severe chronic pain. The modelled population and clinical data were based on a randomised controlled trial in which the main outcome was reduction in pain as measured by the visual analogue scale of pain intensity (VASPI). Resource use data were elicited using a modified Delphi panel and costed using published sources. Utility values were derived from a separate research study. The main outcome measure was the cost per quality-adjusted life-year (QALY). Extensive scenario analysis was conducted to evaluate parameter uncertainty.

Results: Overall, findings were robust to most assumptions. The cost-effectiveness of ziconotide compared to best supportive care (BSC) was £27 443 per QALY (95% CI £18 304–38 504). Scenarios were investigated in which discount rates, the time horizon, the threshold for qualifying as a responder, pump-related assumptions, utilities, ziconotide drug dose, and the patient discontinuation rate with ziconotide were varied. The most sensitive parameter was the dosage of ziconotide: using the lower and upper bounds of the average ziconotide dosage observed in the long-term open-label study changed the incremental cost-effectiveness ratio (ICER) to £15 500 [£8206–25 405] and £44 700 [£30 541–62 670].

Conclusions: Ziconotide may offer an economically feasible alternative solution for patients for whom current treatment is inappropriate or ineffective. The main study limitation is that some model inputs, mainly related to resource use, are based on assumptions or expert interviews.

Keywords: :

• Cost-effectiveness
• Intrathecal
• Pain
• Simulation
• Ziconotide

Transparency

Declaration of funding

This study and the publication of the article were funded by Eisai Europe Limited, the makers of ziconotide.

Declaration of financial/other relationships

L.V. and G.M. have disclosed that they are employees of Eisai Europe Limited. S.D. has disclosed that she is an employee of Services in Health Economics, Belgium (which provides consulting and other research services to pharmaceutical, device, government, and non-government organizations), and that she has received payment from the sponsor for services rendered.

All peer reviewers receive honoraria from CMRO for their review work. Peer Reviewers 1 and 2 have disclosed that they have no relevant financial interests.

Acknowledgements

None.