A pharmacoeconomic evaluation of the pharmacotherapeutic options for painful diabetic neuropathy

ABSTRACT

Introduction

Painful diabetic neuropathy (PDN) is a high incidence and severe complication of diabetes mellitus, significantly compromising patients’ quality of life and causing tremendous economic burden. Considering drug costs becomes part of treatment decisions, with the growing choice of monotherapy or combination treatment strategies for PDN treatment.

Areas covered

This systematic review aims to identify the cost-effectiveness of pharmacotherapies in PDN, summarize key findings, and assess the quality of studies to inform healthcare resource allocation decisions and future research. Economic evaluations were identified by searching PubMed, Web of Science, Scopus and health technology assessment (HTA) databases, as well as screening reference lists of previously identified studies. Relevant data was extracted, and the CHEERS checklist was used to assess the quality of the studies.

Expert opinion

Collectively, the findings indicate that more pharmacoeconomics research is urgently needed to directly compare high-quality research for PDN combination medication/sequential treatment, and which is performed from a societal perspective. Simultaneously, to strengthen the reliability of the analysis, metrics such as adherence, incidence of adverse drug reactions, and pain levels utility value should be examined to verify the robustness of the basic results.

KEYWORDS:

• Painful diabetic neuropathy
• diabetes mellitus
• cost-effectiveness
• pharmacoeconomic evaluation
• pharmacotherapy

Highlights

• Current PDN pharmacoeconomic studies indicated that, when compared to first-line monotherapy regimens, duloxetine was often cost-effective or dominant.

• Insufficient clinical data constrained current pharmacoeconomic evaluation efforts, only a few studies show that pregabalin may be a cost-effective option for PDN combination therapy.

• Further clinical and economic data are needed to determine the cost-effectiveness of PDN combination and sequential pharmacotherapy as a standard clinical treatment.

• Pharmacoeconomic evaluation based on a real-world study framework should be carried out to verify the practical clinical value in treatment decisions.

• Our recommendation for future pharmacoeconomics research is to incorporate indirect costs, compliance, and adverse effects parameters, also construct an appropriate Markov model for the pathophysiology of PDN.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study is supported by the Zhejiang Medical and Health Science and Technology Plan Project (no.2022KY255) and the Construction Fund of Medical Key Disciplines of Hangzhou.