Cost-effectiveness analysis of 5% lidocaine-medicated plaster compared with pregabalin for the treatment of post-herpetic neuralgia in China

Abstract

Background: Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster and is defined as pain that lasts for one month or more after the outbreak itself heals. While the annual incidence of herpes zoster is approximately 3-5%, 9-34% of these patients will develop PHN. Approximately 30-50% of these cases last for more than a year but some cases can persist for 10 years or more. To date, the economic burden of PHN in China has not been studied. The first-line topical therapy for PHN is application of lidocaine-medicated plasters (LMPs) which have shown good efficacy and tolerability. Furthermore, LMPs were added to China's National Health Insurance List in 2019, thereby significantly relieving the financial burden on patients. A cost-effectiveness analysis was performed on LMPs compared with pregabalin in the treatment of PHN to provide a reference for the basis for clinical treatments and health decisions in patients with PHN.Methods: A Markov model was built according to the PHN disease characteristics. The efficacy data were extracted from a randomized controlled trial conducted in China, and the transition probability, utility value, and medical cost of each state in the model were collected through a systematic review of the literature and public databases. The outcome measure was cost per quality-adjusted life year (QALY) gained. The incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analysis was conducted to confirm the robustness of the model. Results:In the base case analysis, treatment for a 6-month period with pregabalin and lidocaine plasters led to a mean QALY gain of 0.34012 and 0.42543, respectively, and mean incremental costs of 5,720 Chinese Yuan (CNY) and 3690 CNY, respectively. The ICER of treatment with 5% lidocaine plaster was negative, indicating that lidocaine plasters had absolute advantage. Monte Carlo simulation resulted in an estimate of 90% probability that the 5% lidocaine plaster treatment was cost-effective.Conclusions: Within the Chinese medical and health system, LMPs can reduce the economic burden of patients with PHN. LMPs are more cost-effective and more efficient in absolute terms compared to the firstline treatment systemic drug pregabalin in the treatment of PHN.

Sponsorship bias in published pharmacoeconomic evaluations of national reimbursement negotiation drugs in China: a systematic review

“…After removing duplicates, we screened 226 records and assessed 138 full-text articles based on inclusion and exclusion criteria. Eventually, 92 pharmacoeconomic evaluations were included in the review and underwent data extraction (figure 1), detailed information on included studies can be found in online supplemental table 2 19–110…”

An analysis and visualization of postherpetic neuralgia research between 1985 and 2022 using scientometrics

“…PHN treatment costs in Ireland range from EUR 140 to EUR 313 per case, and the annual direct costs of treating PHN totaled EUR 179,277 (range: EUR 143,422 to EUR 215,132) [86]. In Italy, the cost per case of PHN is EUR 5,400 [71]. Furthermore, the UK estimates that direct treatment of PHN costs approximately GBP 340 per episode [87].…”

“…Sodium-conducting voltage-gated sodium channels are blocked by lidocaine 5% patches, which reduces ectopic impulses from primary afferent nerves after injury [71]. It is easy to use, well tolerated, has low systemic exposure, and thus, has a low risk of pharmacological interactions [72].…”