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Cost-effectiveness Analysis of Pharmacologic Treatment of

8.20.2018 | Isabella Laird

To identify, from the Mexican Public Health System perspective, which would be the most cost-effective treatment for patients with fibromyalgia (FM). gabapentin (900mg/day), pregabalin (450mg/day), tramadol/acetaminophen (150mg/1300mg/dia) and amitriptyline/fluoxetine (50mg/80mg/dia) for the treatment of FM.

Markov model of the health stages of the fibromyalgia syndrome.

The resulting measures of effectiveness of the model were: (a) the analgesic success rate, measured as the percentage of patients who reduced their VAS by 50% or more compared to the baseline measurement, and b) the rate of overall improvement, calculated by the percentage of patients decreasing the FIQ score by 30% with respect to baseline. Both measures should be achieved and sustained at the end of time horizon (12 months).

The basic model is shown in Fig. 1 . There are 3 health states defined by VAS scores: no pain or mild pain (VAS < 4 points), moderate pain (VAS 4–7 points) and severe pain (VAS > 7 points). Patients entered into the model had moderate to severe pain. The probability of moving to a lower state of pain was identified by modifying the baseline VAS to a decrease in pain of 50% as a result of treatment and a decrease in the FIQ of 30%. The probability of migrating to a state of worst pain was considered treatment failure, which is a function of loss of effectiveness or treatment discontinuation due to intolerance to adverse events, and these were considered for the cases of antidepressants, anticholinergic, serotonin and gastrointestinal effects as well as dizziness and drowsiness produced by ligands of the a2-δ auxiliary subunit receptors. The cycles of the model were defined by periods of 3 months for a total time horizon of 12 months and 4 cycles were built.

Entre las alternativas de tratamiento para el SFM, pregabalina alcanza el mejor control del dolor y es coste-efectiva hasta en el 80% de los pacientes del sistema de salud público en México.

The most important symptom of FMS is chronic pain and its impact is mainly on functionality and quality of life. For the purposes of the model we used the information available through the visual analogue scale (VAS), where 0 represents no pain and 10 the most intense pain imaginable. The functionality in FMS was determined through the FIQ, which measures a multidimensional health status of patients. The FIQ scores are between 0 and 100, where 0 represents the highest functional capacity and 100 the worst state of health. 15 The Markov model employed was adapted from a published study by Tarride et al. 16 While the model mentioned above was designed for another indication (neuropathic pain), different from the present analysis, the inclusion of VAS as a determining factor in assessing the severity of pain has been widely recommended for the evaluation of patients with fibromyalgia according to current literature. 17 On the other hand the assumptions of model were similar, with adult patients ≥18 years of age, diagnosed with fibromyalgia and men and women with chronic musculoskeletal pain. Patients were treated throughout the cycle or the end of the observation period (12 months). According to the natural history of disease we did not consider a risk of death associated with FMS and also not did not consider treatment changes throughout the observation period.

Mediante un modelo de Markov con 3 estados de salud, definidos por la intensidad del dolor (ausencia o presencia de dolor leve; moderado o severo), en ciclos de 3 meses, se estimaron los costes y las efectividades de amitriptilina (50 mg/día), fluoxetina (80 mg/día), duloxetina (120 mg/día), gabapentina (900 mg/día), pregabalina (450 mg/día), tramadol/acetaminofén (150 mg/1300 mg/día) y amitriptilina/fluoxetina (50 mg/80 mg/día) en el tratamiento del SFM. El resultado clínico de interés fue el porcentaje de control del dolor al año de tratamiento. Las probabilidades asignadas al modelo se obtuvieron de la literatura publicada. Los costes médicos directos del tratamiento SFM se calcularon a través bases de datos del Instituto Mexicano del Seguro Social (IMSS) en 2006 y se expresaron en pesos mexicanos de 2010. El análisis de sensibilidad fue probabilístico.

95% CI: 95% confidence interval; Δ Costs: incremental costs, VAS: Visual analog scale; CER: Cost effectiveness ratio; ICER: Incremental cost effectiveness ratio.

The unit cost of the drugs was obtained from the website of the IMSS, which reported the purchase prices of medications bought by the institution in 2007. 30 The information on the cost of the services offered by the IMSS was identified through the IMSS Timely Information Bulletin. 31 All costs were adjusted for cumulative inflation up to December 2010, in accordance with reports by the consumer price index of the Banco de Mexico (4%). The unit cost of each resource and the annual frequency of use are shown in Table 2 .

Frequency of use of drugs expresses the number of tablets or capsules used per year.

Analysis of net savings per capita, on the horizon of 3, 5 and 10 years, is presented in Table 5 ; the data show the difference in costs and changes in the FIQ to be gained by treating patients with pregabalin, gabapentin or duloxetine, in relation to expected with regular use of amitriptyline over time. It is seen that in none of these cases there are savings. However, among these 3 alternatives, pregabalin treatment proves to be a saver with greater global improvement at a lower cost at 3, 5 and 10 years of treatment.

By identifying the health outcomes, the probability of achieving a reduction of VAS over 50% of its baseline score ( Table 3 ) was higher with pregabalin (44.8%), the next best alternative was gabapentin (38.1%) and duloxetine (34.2%). The alternative treatment to lower effectiveness in reducing the VAS score was fluoxetine as monotherapy (6.2%). When analyzing the percentage reduction in the FIQ scale ( Table 4 ), the largest proportion was reached with pregabalin (31.6%), followed by gabapentin (29.1%) and duloxetine (28.5%). The alternative treatment that reached a lower overall improvement measured by the FIQ was fluoxetine as monotherapy.

Clinical Efficacy for the Treatment of Fibromyalgia Comparing Different Drugs.

Among all treatment options for FM, pregabalin achieved the highest pain control and was cost-effective in 80% of patients of the Mexican Public Health System.

Cost Effectiveness Analysis, Global Improvement (FIQ) of Fibromyalgia, IMSS 2010.

In conformity with international guidelines for the treatment of FMS 14 and according to the list of drugs approved by the General Health Council for the care of patients in the public health system of Mexico, we identified the following treatment options: amitriptyline (baseline comparator) in an initial dose of 25 mg/day, and increased to 50 mg/day. The group of SSRIs included fluoxetine, with an initial dose of 20 mg daily and increasing to 80 mg/day and duloxetine at a starting dose of 60 mg/day and 120 mg/day for maintenance. Of the a2-δ ligand drugs, gabapentin was chosen, with an initial dose of 900 mg/day and increased, if necessary, to 1200 mg/day, as well as pregabalin, with an initial dose of 300 mg/day and up to 450 mg/day. We included analgesics such as the combination of tramadol (37.5 mg) with acetaminophen (325 mg) with an initial dose of 150 mg/1300 mg/day and up to 300 mg/2600 mg/day. Finally, we added the combination of fluoxetine plus amitriptyline as an alternative, with starting dose of 20 mg/12.5 mg/day and followed by 80 mg/50 mg/day. 11.

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Cost-effectiveness analysis of pharmacologic treatment of

11.23.2018 | Sophia Campbell
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OBJECTIVE: To identify, from the Mexican Public Health System perspective, which would be the most cost-effective treatment for patients with gabapentin (900 mg/day), pregabalin (450 mg/day), tramadol/acetaminophen (150 mg/1300 mg/día) and amitriptyline/fluoxetine (50mg/80 mg/día) for the.

The lowest treatment costs was for amitriptyline ($ 9047.01), followed by fluoxetine ($ 10,183.89) and amitriptyline/fluoxetine ($ 10,866.01). The best pain control rate was obtained with pregabalin (44.8%), followed by gabapentin (38.1%) and duloxetine (34.2%). By comparing pregabalin vs amitriptyline, additional annual cost per patient for pain control would be around $ 50.000 and $ 75.000 and would result cost-effective in 70% and 80% of all cases.

2011 Elsevier España, S.L.

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Among all treatment options for FM, pregabalin achieved the highest pain control and was cost-effective in 80% of patients of the Mexican Public Health System.

Probabilistic Sensitivity Analyses were conducted. Direct medical costs for FM treatment were retrieved from the 2006 data of the Mexican Institute of Social Security (IMSS) databases and were expressed in 2010 Mexican Pesos. A Markov model including three health states, divided by pain intensity (absence or presence of mild, moderate or severe pain) and considering three-month cycles; costs and effectiveness were estimated for amitriptyline (50mg/day), fluoxetine (80 mg/day), duloxetine (120 mg/day), gabapentin (900 mg/day), pregabalin (450 mg/day), tramadol/acetaminophen (150 mg/1300 mg/día) and amitriptyline/fluoxetine (50mg/80 mg/día) for the treatment of FM. Probabilities assigned to the model were collected from published literature. The clinical outcome considered was the annual rate of pain control.

To identify, from the Mexican Public Health System perspective, which would be the most cost-effective treatment for patients with Fibromyalgia (FM).

National Library of Medicine 8600 Rockville Pike, Bethesda MD, 20894 USA. National Center for Biotechnology Information, U.S.

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