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Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for postherpetic neuralgia in the United Kingdom.
Clin Ther. 2007 Jul; 29(7):1491-507.CT

Abstract

BACKGROUND

Approximately 50% of elderly patients develop postherpetic neuralgia (PHN) after herpes zoster infection (shingles). A lidocaine 5% medicated plaster marketed in the United Kingdom in January 2007 has been shown to be an effective topical treatment for PHN with minimal risk of systemic adverse effects.

OBJECTIVE

This paper assessed the cost-effectiveness of using a lidocaine plaster in place of gabapentin in English primary care practice to treat those PHN patients who had insufficient pain relief with standard analgesics and could not tolerate or had contraindications to tricyclic antidepressants (TCAs). The analysis took the perspective of the National Health Service (NHS).

METHODS

The costs and benefits of gabapentin and the lidocaine plaster were calculated over a 6-month time horizon using a Markov model. The model structure allowed for differences in costs, utilities, and transition probabilities between the initial 30-day run-in period and maintenance therapy and also accounted for add-in medications and drugs received by patients who discontinued therapy. Most transition probabilities were based on non-head-to-head clinical trials identified through a systematic review. Data on resource utilization, discontinuation rates, and add-in or switch medications were obtained from a Delphi panel; cost data were from official price tariffs. Published utilities were adjusted for age and were supplemented and validated by the Delphi panel.

RESULTS

Six months of therapy with the lidocaine plaster cost pound 549 per patient, compared with pound 718 for gabapentin, and generated 0.05 more quality-adjusted life-years (QALYs). The lidocaine plaster therefore dominated gabapentin (95% CI, dominant- pound 2163/QALY gained). Probabilistic sensitivity analysis showed that there was a 90.15% chance that the lidocaine plaster was both less costly and more effective than gabapentin and a 99.99% chance that it cost < pound 20,000/QALY relative to gabapentin. Extensive deterministic sensitivity analyses confirmed the robustness of the conclusions.

CONCLUSION

This study found that the lidocaine 5% medicated plaster was a cost-effective alternative to gabapentin for PHN patients who were intolerant to TCAs and in whom analgesics were ineffective, from the perspective of the NHS.

Authors+Show Affiliations

Abacus International, Bicester, Oxfordshire, United Kingdom. helen.dakin@abacusint.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17825701

Citation

Dakin, Helen, et al. "Cost-effectiveness of a Lidocaine 5% Medicated Plaster Relative to Gabapentin for Postherpetic Neuralgia in the United Kingdom." Clinical Therapeutics, vol. 29, no. 7, 2007, pp. 1491-507.
Dakin H, Nuijten M, Liedgens H, et al. Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for postherpetic neuralgia in the United Kingdom. Clin Ther. 2007;29(7):1491-507.
Dakin, H., Nuijten, M., Liedgens, H., & Nautrup, B. P. (2007). Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for postherpetic neuralgia in the United Kingdom. Clinical Therapeutics, 29(7), 1491-507.
Dakin H, et al. Cost-effectiveness of a Lidocaine 5% Medicated Plaster Relative to Gabapentin for Postherpetic Neuralgia in the United Kingdom. Clin Ther. 2007;29(7):1491-507. PubMed PMID: 17825701.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for postherpetic neuralgia in the United Kingdom. AU - Dakin,Helen, AU - Nuijten,Mark, AU - Liedgens,Hiltrud, AU - Nautrup,Barbara Poulsen, PY - 2007/05/22/accepted PY - 2007/9/11/pubmed PY - 2007/10/10/medline PY - 2007/9/11/entrez SP - 1491 EP - 507 JF - Clinical therapeutics JO - Clin Ther VL - 29 IS - 7 N2 - BACKGROUND: Approximately 50% of elderly patients develop postherpetic neuralgia (PHN) after herpes zoster infection (shingles). A lidocaine 5% medicated plaster marketed in the United Kingdom in January 2007 has been shown to be an effective topical treatment for PHN with minimal risk of systemic adverse effects. OBJECTIVE: This paper assessed the cost-effectiveness of using a lidocaine plaster in place of gabapentin in English primary care practice to treat those PHN patients who had insufficient pain relief with standard analgesics and could not tolerate or had contraindications to tricyclic antidepressants (TCAs). The analysis took the perspective of the National Health Service (NHS). METHODS: The costs and benefits of gabapentin and the lidocaine plaster were calculated over a 6-month time horizon using a Markov model. The model structure allowed for differences in costs, utilities, and transition probabilities between the initial 30-day run-in period and maintenance therapy and also accounted for add-in medications and drugs received by patients who discontinued therapy. Most transition probabilities were based on non-head-to-head clinical trials identified through a systematic review. Data on resource utilization, discontinuation rates, and add-in or switch medications were obtained from a Delphi panel; cost data were from official price tariffs. Published utilities were adjusted for age and were supplemented and validated by the Delphi panel. RESULTS: Six months of therapy with the lidocaine plaster cost pound 549 per patient, compared with pound 718 for gabapentin, and generated 0.05 more quality-adjusted life-years (QALYs). The lidocaine plaster therefore dominated gabapentin (95% CI, dominant- pound 2163/QALY gained). Probabilistic sensitivity analysis showed that there was a 90.15% chance that the lidocaine plaster was both less costly and more effective than gabapentin and a 99.99% chance that it cost < pound 20,000/QALY relative to gabapentin. Extensive deterministic sensitivity analyses confirmed the robustness of the conclusions. CONCLUSION: This study found that the lidocaine 5% medicated plaster was a cost-effective alternative to gabapentin for PHN patients who were intolerant to TCAs and in whom analgesics were ineffective, from the perspective of the NHS. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/17825701/Cost_effectiveness_of_a_lidocaine_5_medicated_plaster_relative_to_gabapentin_for_postherpetic_neuralgia_in_the_United_Kingdom_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(07)00186-5 DB - PRIME DP - Unbound Medicine ER -