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A cost-effectiveness comparison of desipramine, gabapentin, and pregabalin for treating postherpetic neuralgia.
J Am Geriatr Soc. 2007 Aug; 55(8):1176-84.JA

Abstract

OBJECTIVES

To compare the net health effects and costs resulting from treatment with different first-line postherpetic neuralgia (PHN) medications.

DESIGN

Cost-utility analysis using published literature.

PARTICIPANTS

Hypothetical cohort of patients aged 60 to 80 with PHN.

INTERVENTIONS

Desipramine 100 mg/d, gabapentin 1,800 mg/d, and pregabalin 450 mg/d.

MEASUREMENTS

A decision model was designed to describe possible treatment outcomes, including different combinations of analgesia and side effects, during the first 3 months of therapy for moderate to severe PHN. The main outcome was cost per quality-adjusted life-year (QALY) gained. Costs were estimated using the perspective of a third-party payer. Multivariate, univariate, and probabilistic sensitivity analyses were performed, and the time frame of the model was varied to 1-month and 6-month horizons.

RESULTS

Desipramine was more effective and less expensive than gabapentin or pregabalin (dominant) under all conditions tested. Gabapentin was more effective than pregabalin but at an incremental cost of $216,000/QALY. Below $140/month, gabapentin became more cost-effective than pregabalin at a threshold of $50,000/QALY, and below $115/month gabapentin dominated pregabalin.

CONCLUSION

Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost-effective than pregabalin.

Authors+Show Affiliations

Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA. alec_oconnor@urmc.rochester.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

17661955

Citation

O'Connor, Alec B., et al. "A Cost-effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia." Journal of the American Geriatrics Society, vol. 55, no. 8, 2007, pp. 1176-84.
O'Connor AB, Noyes K, Holloway RG. A cost-effectiveness comparison of desipramine, gabapentin, and pregabalin for treating postherpetic neuralgia. J Am Geriatr Soc. 2007;55(8):1176-84.
O'Connor, A. B., Noyes, K., & Holloway, R. G. (2007). A cost-effectiveness comparison of desipramine, gabapentin, and pregabalin for treating postherpetic neuralgia. Journal of the American Geriatrics Society, 55(8), 1176-84.
O'Connor AB, Noyes K, Holloway RG. A Cost-effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia. J Am Geriatr Soc. 2007;55(8):1176-84. PubMed PMID: 17661955.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A cost-effectiveness comparison of desipramine, gabapentin, and pregabalin for treating postherpetic neuralgia. AU - O'Connor,Alec B, AU - Noyes,Katia, AU - Holloway,Robert G, PY - 2007/7/31/pubmed PY - 2007/10/3/medline PY - 2007/7/31/entrez SP - 1176 EP - 84 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 55 IS - 8 N2 - OBJECTIVES: To compare the net health effects and costs resulting from treatment with different first-line postherpetic neuralgia (PHN) medications. DESIGN: Cost-utility analysis using published literature. PARTICIPANTS: Hypothetical cohort of patients aged 60 to 80 with PHN. INTERVENTIONS: Desipramine 100 mg/d, gabapentin 1,800 mg/d, and pregabalin 450 mg/d. MEASUREMENTS: A decision model was designed to describe possible treatment outcomes, including different combinations of analgesia and side effects, during the first 3 months of therapy for moderate to severe PHN. The main outcome was cost per quality-adjusted life-year (QALY) gained. Costs were estimated using the perspective of a third-party payer. Multivariate, univariate, and probabilistic sensitivity analyses were performed, and the time frame of the model was varied to 1-month and 6-month horizons. RESULTS: Desipramine was more effective and less expensive than gabapentin or pregabalin (dominant) under all conditions tested. Gabapentin was more effective than pregabalin but at an incremental cost of $216,000/QALY. Below $140/month, gabapentin became more cost-effective than pregabalin at a threshold of $50,000/QALY, and below $115/month gabapentin dominated pregabalin. CONCLUSION: Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost-effective than pregabalin. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/17661955/A_cost_effectiveness_comparison_of_desipramine_gabapentin_and_pregabalin_for_treating_postherpetic_neuralgia_ L2 - https://doi.org/10.1111/j.1532-5415.2007.01246.x DB - PRIME DP - Unbound Medicine ER -