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Sequential medication strategies for postherpetic neuralgia: a cost-effectiveness analysis
Kenneth J Smith1, Mark S Roberts
1Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. smithkj2@upmc.edu
The Journal of Pain
|January 24, 2007
Summary
This study found that recommended sequential treatment algorithms for postherpetic neuralgia (PHN) are cost-effective. Gabapentin is often favored for initial PHN treatment, especially in patients with coronary artery disease.
Area of Science:
- Pharmacoeconomics
- Pain Management
- Clinical Decision Analysis
Background:
- Postherpetic neuralgia (PHN) management involves several recommended medications.
- A sequential treatment algorithm exists, but its cost-effectiveness requires evaluation.
Purpose of the Study:
- To estimate the cost-effectiveness of a suggested sequential medication algorithm for PHN in 70-year-olds.
- To compare this algorithm against alternative sequential strategies.
Main Methods:
- A decision model was developed using literature data on medication relief and side effects.
- Analysis considered hypothetical patients with and without coronary artery disease (CAD), and localized pain.
- Probabilistic sensitivity analyses were performed to assess early treatment favorability.
Main Results:
- Gabapentin was strongly favored for initial therapy in patients with CAD and those without CAD if tricyclic mortality risk was considered.
- Tricyclic and gabapentin were equally favored initially in patients without CAD if tricyclic mortality risk was not increased.
- Opioids, pregabalin, and tramadol were suitable for later treatment stages; lidocaine patch was reasonable for localized PHN.
Conclusions:
- The suggested sequential treatment algorithm for PHN is supported by this analysis.
- Recommended treatment algorithms demonstrate economic reasonableness based on effectiveness and tolerability data.
