Natalia Ruiz-Negrón1, Jyothi Menon2, Jordan B King3, Junjie Ma4, Brandon K Bellows5. 1. Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA. natalia.ruiz@pharm.utah.edu. 2. Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT, USA. 3. Department of Pharmacy, Kaiser Permanente, Aurora, CO, USA. 4. Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA. 5. Division of General Medicine, Columbia University, New York, NY, USA.
Abstract
BACKGROUND: Neuropathic pain significantly reduces an individual's quality of life and places a significant economic burden on society. As such, many cost-effectiveness analyses (CEAs) have been published for treatments available for neuropathic pain. OBJECTIVES: The primary objective of this systematic review was to provide a detailed summary of the estimates of cost-effectiveness from published CEAs comparing available treatments for neuropathic pain. The secondary objectives were to identify the key drivers of cost-effectiveness and to assess the quality of published CEAs in neuropathic pain. METHODS: We searched Embase, MEDLINE, Cochrane CENTRAL and seven other databases to identify CEAs reporting the costs, health benefits (e.g., quality-adjusted life-years or disability-adjusted life-years) and summary statistics, such as incremental cost-effectiveness ratios, of treatments for neuropathic pain. We excluded studies reporting diseases other than neuropathic pain, those for which the full text was not available (e.g., conference abstracts), studies not written in English or not published in peer-reviewed journals, and narrative reviews, editorials and opinion papers. Titles and abstract reviews, full-text reviews, and data extraction were all performed by two independent reviewers, with disagreement resolved by a third reviewer. Mean costs, health benefits, and summary statistics were reported and qualitatively compared across studies, stratified by time horizon. Drivers of cost-effectiveness were assessed using reported one-way sensitivity analyses. The quality of all included studies was evaluated using the Tufts CEA Registry Quality Score and study reporting using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist. RESULTS: A total of 22 studies were identified and included in this systematic review. Included studies were heterogeneous in the treatments compared, methodology and design, perspectives, and time horizons considered, making cross-study comparisons difficult. No single treatment was consistently the most cost-effective across all studies, but tricyclic antidepressants were the preferred treatment at a willingness-to-pay threshold of $US50,000 per quality-adjusted life-year in several studies with a short time horizon and a US payer perspective. Among the 14 studies reporting one-way sensitivity analyses, drivers of cost-effectiveness included utility values for health states and the likelihood of pain relief with treatment. The quality of the identified CEAs was moderate to high, and overall reporting largely met CHEERS recommendations. LIMITATIONS: To assess drivers of cost-effectiveness and quality, we only included studies with the full text available and thus excluded some CEAs that reported cost-effectiveness results. The heterogeneity of the included studies meant that the study results could not be synthesized and comparison across studies was limited. CONCLUSIONS: Though many pulished studies have evaluated the cost-effectiveness of treatments for neuropathic pain, significant heterogeneity between CEAs prevented synthesis of the results. Standardized methodology and improved reporting would allow for more reliable comparisons across studies.
BACKGROUND:Neuropathic pain significantly reduces an individual's quality of life and places a significant economic burden on society. As such, many cost-effectiveness analyses (CEAs) have been published for treatments available for neuropathic pain. OBJECTIVES: The primary objective of this systematic review was to provide a detailed summary of the estimates of cost-effectiveness from published CEAs comparing available treatments for neuropathic pain. The secondary objectives were to identify the key drivers of cost-effectiveness and to assess the quality of published CEAs in neuropathic pain. METHODS: We searched Embase, MEDLINE, Cochrane CENTRAL and seven other databases to identify CEAs reporting the costs, health benefits (e.g., quality-adjusted life-years or disability-adjusted life-years) and summary statistics, such as incremental cost-effectiveness ratios, of treatments for neuropathic pain. We excluded studies reporting diseases other than neuropathic pain, those for which the full text was not available (e.g., conference abstracts), studies not written in English or not published in peer-reviewed journals, and narrative reviews, editorials and opinion papers. Titles and abstract reviews, full-text reviews, and data extraction were all performed by two independent reviewers, with disagreement resolved by a third reviewer. Mean costs, health benefits, and summary statistics were reported and qualitatively compared across studies, stratified by time horizon. Drivers of cost-effectiveness were assessed using reported one-way sensitivity analyses. The quality of all included studies was evaluated using the Tufts CEA Registry Quality Score and study reporting using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist. RESULTS: A total of 22 studies were identified and included in this systematic review. Included studies were heterogeneous in the treatments compared, methodology and design, perspectives, and time horizons considered, making cross-study comparisons difficult. No single treatment was consistently the most cost-effective across all studies, but tricyclic antidepressants were the preferred treatment at a willingness-to-pay threshold of $US50,000 per quality-adjusted life-year in several studies with a short time horizon and a US payer perspective. Among the 14 studies reporting one-way sensitivity analyses, drivers of cost-effectiveness included utility values for health states and the likelihood of pain relief with treatment. The quality of the identified CEAs was moderate to high, and overall reporting largely met CHEERS recommendations. LIMITATIONS: To assess drivers of cost-effectiveness and quality, we only included studies with the full text available and thus excluded some CEAs that reported cost-effectiveness results. The heterogeneity of the included studies meant that the study results could not be synthesized and comparison across studies was limited. CONCLUSIONS: Though many pulished studies have evaluated the cost-effectiveness of treatments for neuropathic pain, significant heterogeneity between CEAs prevented synthesis of the results. Standardized methodology and improved reporting would allow for more reliable comparisons across studies.
Authors: S Tesfaye; L K Stevens; J M Stephenson; J H Fuller; M Plater; C Ionescu-Tirgoviste; A Nuber; G Pozza; J D Ward Journal: Diabetologia Date: 1996-11 Impact factor: 10.122
Authors: Robert H Dworkin; Dennis C Turk; John T Farrar; Jennifer A Haythornthwaite; Mark P Jensen; Nathaniel P Katz; Robert D Kerns; Gerold Stucki; Robert R Allen; Nicholas Bellamy; Daniel B Carr; Julie Chandler; Penney Cowan; Raymond Dionne; Bradley S Galer; Sharon Hertz; Alejandro R Jadad; Lynn D Kramer; Donald C Manning; Susan Martin; Cynthia G McCormick; Michael P McDermott; Patrick McGrath; Steve Quessy; Bob A Rappaport; Wendye Robbins; James P Robinson; Margaret Rothman; Mike A Royal; Lee Simon; Joseph W Stauffer; Wendy Stein; Jane Tollett; Joachim Wernicke; James Witter Journal: Pain Date: 2005-01 Impact factor: 6.961
Authors: Marina de Salas-Cansado; Concepción Pérez; María T Saldaña; Ana Navarro; Francisco J González-Gómez; Lucía Ruiz; Javier Rejas Journal: Prim Care Diabetes Date: 2012-05-15 Impact factor: 2.459
Authors: Pierre Chevalier; Mark Lamotte; Hilde Van Campenhout; Roman Eyckerman; Lieven Annemans Journal: J Med Econ Date: 2013-03-04 Impact factor: 2.448
Authors: Rodica Pop-Busui; Andrew J M Boulton; Eva L Feldman; Vera Bril; Roy Freeman; Rayaz A Malik; Jay M Sosenko; Dan Ziegler Journal: Diabetes Care Date: 2017-01 Impact factor: 19.112