PMID- 20067326
OWN - NLM
STAT- MEDLINE
DCOM- 20100405
LR  - 20211020
IS  - 1173-2563 (Print)
IS  - 1173-2563 (Linking)
VI  - 30
IP  - 2
DP  - 2010
TI  - Cost effectiveness of a lidocaine 5% medicated plaster compared with pregabalin 
      for the treatment of postherpetic neuralgia in the UK: a Markov model analysis.
PG  - 71-87
LID - 10.2165/11533310-000000000-00000 [doi]
AB  - BACKGROUND: Published analyses have demonstrated that the lidocaine (lignocaine) 
      plaster is a cost-effective treatment for postherpetic neuralgia (PHN) relative 
      to gabapentin or pregabalin. However, these analyses have been based on indirect 
      comparisons from placebo-controlled trials, and there is evidence of a 
      discrepancy between the outcomes of direct and indirect analyses. Fortunately, 
      recent publication of the results of a head-to-head trial comparing the lidocaine 
      plaster and pregabalin in patients with PHN or diabetic polyneuropathy allows 
      customization of the existing model to more accurately reflect the relative cost 
      effectiveness of these two products. OBJECTIVE: To assess the cost-effectiveness 
      of the lidocaine 5% medicated plaster compared with pregabalin for the treatment 
      of PHN in the UK primary-care setting. METHODS: A Markov model has been developed 
      to assess the costs and benefits of the lidocaine plaster and pregabalin over a 
      6-month time horizon for the treatment of patients with PHN who are intolerant to 
      tricyclic antidepressants and in whom analgesics are ineffective or 
      contraindicated. The model structure allows for differences in costs, utilities 
      (derived from published data and from the head-to-head trial) and transition 
      probabilities between the initial 30-day run-in period and maintenance therapy, 
      and also takes account of add-in medication and drugs received by patients 
      discontinuing therapy. The calculation was based on data from the recent 
      head-to-head trial described above. Additional data sources included published 
      literature, discussions with a Delphi panel, official price/tariff lists and 
      national population statistics. The study was conducted from the perspective of 
      the UK National Health Service (NHS). RESULTS: The base-case analysis (1.71 
      lidocaine plasters per day used in the head-to-head trial for the PHN population) 
      indicated that the total cost of treating PHN patients for 6 months with the 
      lidocaine plaster was pound 980 per patient treated, compared with pound 784 for 
      pregabalin (year of costing 2009). Costs for 1 month without pain and intolerable 
      adverse events (AEs) (modified TWIST analysis) were pound 126 for the lidocaine 
      plaster relative to pregabalin. The average patient treated with the lidocaine 
      plaster experienced 0.321 quality-adjusted life-years (QALYs) over the 6-month 
      period modelled compared with 0.254 QALYs for pregabalin. Quality-of-life 
      benefits were attributed to the favourable AE profile of the lidocaine plaster. 
      Subsequently, the lidocaine plaster cost pound 2925 per QALY gained relative to 
      pregabalin. However, patient level longitudinal data have shown that the actual 
      clinical usage of the lidocaine plaster is 1.1 plasters per day. If this more 
      realistic assumption is used in the model, the total cost for a 6-month treatment 
      period was pound 756 for the lidocaine plaster, which dominated treatment with 
      pregabalin. Scenario analyses and sensitivity analyses had minimal impact on the 
      results, confirming the robustness of the study. The incremental 
      cost-effectiveness ratios for the lidocaine plaster remained well below pound 
      35,000 per QALY gained in all analyses. CONCLUSION: This analysis showed that the 
      lidocaine 5% medicated plaster is a cost-effective method for obtaining sustained 
      relief of localized neuropathic pain associated with PHN compared with pregabalin 
      in a UK setting, in terms of both the cost per QALY gained and the cost per 
      additional month without symptoms, when used for patients who do not experience 
      sufficient pain relief from standard analgesics.
FAU - Ritchie, Mark
AU  - Ritchie M
AD  - Dr Baker & Partners, Morriston, Great Britain.
FAU - Liedgens, Hiltrud
AU  - Liedgens H
FAU - Nuijten, Mark
AU  - Nuijten M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Clin Drug Investig
JT  - Clinical drug investigation
JID - 9504817
RN  - 0 (Analgesics)
RN  - 0 (Anesthetics, Local)
RN  - 55JG375S6M (Pregabalin)
RN  - 56-12-2 (gamma-Aminobutyric Acid)
RN  - 98PI200987 (Lidocaine)
SB  - IM
MH  - Administration, Topical
MH  - Analgesics/administration & dosage/*economics/*therapeutic use
MH  - Anesthetics, Local/administration & dosage/*economics/*therapeutic use
MH  - Cost-Benefit Analysis
MH  - Data Interpretation, Statistical
MH  - Delphi Technique
MH  - Humans
MH  - Lidocaine/administration & dosage/*economics/*therapeutic use
MH  - Markov Chains
MH  - Models, Statistical
MH  - Neuralgia, Postherpetic/*drug therapy
MH  - Pregabalin
MH  - Probability Theory
MH  - Quality-Adjusted Life Years
MH  - United Kingdom
MH  - gamma-Aminobutyric Acid/administration & dosage/*analogs & 
      derivatives/economics/therapeutic use
EDAT- 2010/01/14 06:00
MHDA- 2010/04/07 06:00
CRDT- 2010/01/14 06:00
PHST- 2010/01/14 06:00 [entrez]
PHST- 2010/01/14 06:00 [pubmed]
PHST- 2010/04/07 06:00 [medline]
AID - 1 [pii]
AID - 10.2165/11533310-000000000-00000 [doi]
PST - ppublish
SO  - Clin Drug Investig. 2010;30(2):71-87. doi: 10.2165/11533310-000000000-00000.