Evaluation of healthcare resource utilization and costs in employees with pain associated with diabetic peripheral neuropathy treated with pregabalin or duloxetine

Abstract

Objective:

To evaluate changes in healthcare resource use and costs after initiating pregabalin or duloxetine in employees with pain associated with diabetic peripheral neuropathy (pDPN).

Methods:

Employees (18–64 years old) with a DPN diagnosis and at least one pDPN-related pain medication claim were identified using the MarketScan Commercial Database (2005–2008). Propensity scored matched pregabalin and duloxetine new starts were evaluated in the 6-month pre- and 6-month post-initiation periods. Study outcomes including imputed medically-related work loss, prescription and healthcare utilization, and associated expenditures were analyzed using univariate statistics and multivariate models in a difference-in-difference approach.

Results:

A total of 473 employees in each treatment group were identified. Mean age was 53.6 (SD 7.0) years for pregabalin and 53.5 (SD 7.4) years for duloxetine. There were no pre-index differences between groups. Adjusted marginal effects were not statistically significant for pre-to-post changes in opioid utilization (p = 0.328), number of pDPN-related analgesic medications (p = 0.506), all-cause healthcare costs (p = 0.895), indirect costs (p = 0.324), or pDPN-attributable expenditures (p = 0.359).

Limitations:

Claims analysis is limited in accounting for all patient and plan differences, and by the reliability of medical claims for diagnosis coding. The sample size of the matched cohorts may have limited the power of the analysis to detect differences.

Conclusions:

There were no significant pre-to-post differences between pregabalin and duloxetine treatment groups in pDPN-related analgesic medication use, or pDPN-attributable, all-cause, and indirect expenditures.

Key words::

• Diabetic peripheral neuropathy
• Duloxetine
• Neuropathic pain
• Pregabalin

Transparency

Declaration of funding

This study was sponsored by Pfizer Inc, New York, NY, USA.

Declaration of financial/other relationships

J.M., Z.C., and R.F are employees of Thomson Reuters, who was paid by Pfizer Inc in connection with the development of this manuscript. S.L.S. was a paid consultant to Pfizer Inc in connection with the development of this manuscript. J.H., R.J.S. and J.M. are employees of Pfizer Inc, manufacturer of pregabalin.

Acknowledgments

The authors wish to acknowledge the key contributions of Bevan Kirley, MS, whose tireless work in defining, extracting, assembling, and analyzing the data helped make this research possible.

Selected results from this study were previously presented in a poster at the International Society for Pharmacoeconomics and Outcomes Research 15th Annual International Meeting, May 15–19, 2010, in Atlanta, GA, USA.