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

Abstract

Objective:

To perform an economic evaluation of duloxetine, pregabalin, and both branded and generic gabapentin for managing pain in patients with painful diabetic peripheral neuropathy (PDPN) in Mexico.

Research design and methods:

The analysis was conducted using a 3-month decision model, which compares duloxetine 60 mg once daily (DUL), pregabalin 150 mg twice daily (PGB), and gabapentin 600 mg three-times daily (GBP) for PDPN patients with moderate-to-severe pain. A systematic review was performed and placebo-adjusted risk ratios for achieving good pain relief (GPR), adverse events (AE), and withdrawal owing to intolerable AE were calculated. Direct medical costs included drug acquisition and additional visits due to lack of efficacy (poor pain relief) or intolerable AE. Unit costs were taken from local sources. Adherence rates were used to estimate the expected drug costs. All costs are expressed in 2010 Mexican Pesos (MXN). Utility values drawn from published literature were applied to health states. The proportion of patients with GPR and quality-adjusted life years (QALY) were assessed.

Results:

Branded-GBP was dominated by all the other options. PGB was more costly and less effective than DUL. Compared with branded-GBP and PGB, DUL led to savings of 1.01 and 1.74 million MXN (per 1000 patients). The incremental cost per QALY gained with DUL used instead of generic-GBP was $102 433 MXN. This amount is slightly lower than the estimated gross domestic product per capita in Mexico for 2010. During a second-order Monte Carlo simulation, DUL had the highest probability of being cost-effective (61%), followed by generic-GBP (25%) and PGB (14%).

Limitations:

Study limitations include a short timeframe and using data from different dosage schemes for GBP and PGB.

Conclusions:

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.

Keywords::

• Cost-effectiveness
• Duloxetine
• Pregabalin
• Gabapentin
• Painful diabetic neuropathy
• Mexico

Transparency

Declaration of funding

Funding for this study was provided by Eli Lilly y Compañía de México, S.A. de C.V.

Declaration of financial/other relationship

Authors Jocelyn Ramírez-Gámez, Héctor Dueñas, and Rosa María Galindo-Suárez are or were employees of Eli Lilly y Compañía de México, S.A. de C.V. when this study was conducted. Author Fernando Carlos has received funds for health economics research from Eli Lilly y Compañía de México, S.A. de C.V. and Pfizer, S.A. de C.V. over the past 12 months. Author Elisa Ramos has no conflict of interest to report.

Acknowledgments

No assistance in the preparation of this article is to be declared. This study was presented in poster format at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 3rd Latin American Conference; Mexico City, Mexico; September 8–10, 2011.