The Cost-Effectiveness of Duloxetine in Chronic Low Back Pain: A US Private Payer Perspective

Wielage, Ronald C.; Bansal, Megha; Andrews, Jeffrey Scott; Wohlreich, Madelaine M.; Klein, Robert W.; Happich, Michael

doi:10.1016/j.jval.2012.12.006

Cited by 27 publications

(33 citation statements)

References 80 publications

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“…Standard care 190,000 (low risk with uterus) 100,000 72,000 (low risk without uterus) 57,000 (high risk with uterus) 37,000 (high risk without uterus) Breast cancer 20 Adjuvant trastuzumab Standard care 39,000 N/A Breast cancer 21 Anastrozole Tamoxifen 26 OnabotulinumtoxinA Best supportive care 24,000 N/A Knee osteoarthritis 27 Disease-modifying osteoarthritis drugs Standard care 57,000 N/A Chronic low back pain 28 Duloxetine Naproxen 59,473 N/A Human immunodeficiency virus 29 Generic-based antiretroviral therapy No antiretroviral therapy 21,000 100,000 Branded antiretroviral therapy Generic-based antiretroviral therapy 114,000 Type 2 diabetes 30 Exenatide Insulin glargine 15,000 N/A ADHD 31 Guanfacine XR + stimulant Stimulant monotherapy 31,000 50,000 Anticoagulation in cancer patients 32 Low molecular-weight heparin No prophylaxis 90,893 N/A Stroke prevention in atrial fibrillation 33 Rivaroxaban Warfarin 27,000 100,000 Multiple sclerosis 34 Fingolimod IFN beta-1a 73,000 100,000 S. aureus vaccine in hemodialysis patients 35 Vaccine (1% colonization rate) No vaccine 25,217 N/A Schizophrenia 36 Olanzapine ODT SOT 19,000 N/A Olanzapine ODT Risperidone SOT 39,000 End-stage renal disease 37 Erythropoietin stimulating agents Routine blood transfusions 873 N/A Hyperlipidemia 38 Atorvastatin Simvastatin 45,000 N/A Acute coronary syndrome 39 Ticagrelor Genotype-driven treatment 10,000 50,000 Human immunodeficiency virus 40 Atazanavir -ritonavir Lopinavir -ritonavir 26,000 50,000 Type 2 diabetes 41 Liraglutide Exenatide 40,000 N/A Human immunodeficiency virus 42 Darunavir -ritonavir Lopinavir -ritonavir 23,000 N/A Macular degeneration 43 Bevacizumab Ranibizumab -54,000 N/A Cardiovascular disease 44 Rosuvastatin (20-year horizon) Placebo 10,000 N/A Rosuvastatin (10-year horizon) 44 …”

Section: Tamoxifenmentioning

confidence: 99%

Do Value Thresholds for Oncology Drugs Differ from Nononcology Drugs?

Bae

Mullins²

2014

JMCP

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BACKGROUND: In the past decade, many oncologic drugs have been approved that extend life and/or improve patients' quality of life. However, new cancer drugs are often associated with high price and increased medical spending. For example, in 2010, the average annual cost of care for breast cancer in the final stage of disease was reported to be $94,284, and the total estimated cost in the United States was $16.50 billion.

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Section: Tamoxifenmentioning

confidence: 99%

Do Value Thresholds for Oncology Drugs Differ from Nononcology Drugs?

Bae

Mullins²

2014

JMCP

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“…Naproxen may be a cost-effective treatment compared with other traditional NSAIDs and coxibs, particularly in patients at high risk. 135,136 When taking into account the overall costs, benefits, and risks, newly approved topical NSAIDs and combination formulations (containing an NSAID and a gastroprotective agent) may be cost-effective over the long term; however, these regimens have not been well established.…”

Section: Balancing the Risks: Use Of Nsaids In Patients With Gastroinmentioning

confidence: 99%

NSAIDs for Musculoskeletal Pain Management: Current Perspectives and Novel Strategies to Improve Safety

Atchison¹,

Herndon²,

Rusie³

2013

JMCP

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and completed residency training in physical medicine and rehabilitation at The Ohio State University. Dr. Atchison has been in practice at academic medical centers for more than 20 years, serving on the faculty at the University of Kentucky and University of Florida before his appointment at Northwestern University. A recognized teacher and researcher in the field of pain management and rehabilitation, he has presented courses, lectures, and workshops nationally and internationally on pharmacological and nonpharmacological therapies, care of spinal injuries, and spinal manipulation. Dr. Atchison has led and participated in many research projects, including several funded by the National Institutes of Health. He has authored numerous research papers and book chapters, and he serves as a peer reviewer for the Archives of Physical Medicine and Rehabilitation. He has been a member of the editorial boards of the Supplement Policy Statement Standards for Supplements to the Journal of Managed Care PharmacySupplements to the Journal of Managed Care Pharmacy are intended to support medical education and research in areas of clinical practice, health care quality improvement, or efficient administration and delivery of health benefits. The following standards are applied to all JMCP supplements to ensure quality and assist readers in evaluating potential bias and determining alternate explanations for findings and results. 1. Disclose the principal sources of funding in a manner that permits easy recognition by the reader. 2. Disclose the existence of all potential conflicts of interest among supplement contributors, including financial or personal bias. 3. Describe all drugs by generic name unless the use of the brand name is necessary to reduce the opportunity for confusion among readers. 4. Identify any off-label (unapproved) use by drug name and specific off-label indication. 5. Strive to report subjects of current interest to managed care pharmacists and other managed care professionals. S14 Multitarget Drugs S15 Conclusions S15 References Target AudiencesThis CME/CE activity is designed to meet the educational needs of pharmacists, physicians, nurse practitioners, and nurses. Learning Objectives• Assess patient-specific risk factors in selecting NSAIDs for mild-to-moderate musculoskeletal pain • Incorporate risk/benefit analysis in decision making about NSAID use • Use evidence-based guidelines for selecting NSAID therapy and applying strategies to prevent complications • Evaluate the efficacy, safety, and pharmacological profile of new and emerging NSAID formulations Funding This supplement was funded by an independent educational grant to PRIME Education, Inc. (PRIME) from Iroko Pharmaceuticals, LLC. Accreditation StatementsIn support of improving patient care, PRIME Education, Inc. (PRIME) is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing educat...

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“…A total of seven studies were included after screening the 101 records found in the search. Three were from the USA [12,14,15], two from Canada [11,16], and one each from England [17] and Spain [18]. Two US papers from the same group of authors [14,15] describe research undertaken in one private pain management practice in a nonuniversity setting; the earlier study presents the results of a non-randomised study and the latter that of the combined results of four RCTs.…”

Section: Methodsmentioning

confidence: 99%

“…One of these [17] used a multiattribute utility instrument, the EQ5D thus enabling the calculation of quality-adjusted life years (QALYs); the other used the SF12 but did not convert this to QALYs [18]. In the two studies that used the NICE model, QALYs were reported [11,12]. In both studies, QALY weights (utilities) were estimated via a meta-analysis of clinical trials; pain scores were converted to utilities using a transfer-to-utilities regression equation using published sources and population-based utility weights, and adverse event weights were also derived from published sources.…”

Section: Methodsmentioning

confidence: 99%

“…The National Institute of Health and Care Excellence (NICE) reported that no economic models could be located for NSAIDs, opioids or anti-depressants for its 2009 guideline for LBP [10]. Recently, however, two studies investigating the cost-effectiveness of duloxetine (a selective serotonin and norepinephrine reuptake inhibitor) in CLBP have been published [11,12], prompting renewed interest in the relative cost-effectiveness of medications for CLBP. Thus, the purpose of this review was to evaluate published economic evaluations of pharmacological management for CLBP.…”

Section: Introductionmentioning

confidence: 99%

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Pharmacological Management of Chronic Lower Back Pain: A Review of Cost Effectiveness

Haas

Lourenço

2015

PharmacoEconomics

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Lower back pain is one of the most prevalent musculoskeletal conditions in the developed world and accounts for significant health services use. The American College of Physicians and the American Pain Society have published a joint clinical guideline that recommends providing patients with information on prognosis and self-management, the use of medications with proven benefits and, for those who do not improve, consideration be given to the use of spinal manipulation (for acute lower back pain only), interdisciplinary rehabilitation, exercise, acupuncture, massage, yoga, cognitive behavioural therapy or relaxation. The purpose of this review was to evaluate published economic evaluations of pharmacological management for chronic lower back pain. A total of seven studies were eligible for inclusion in there view. The quality of the economic evaluations undertaken in the included studies was not high. This was primarily because of the nature of the underlying clinical evidence, most of which did not come from rigorous randomised controlled trials (RCTs), and the manner in which it was incorporated into the economic evaluations. All studies provided reasonable information about what aspects of healthcare and other resource use were identified, measured and valued. However, the reporting of total costs was not uniform across studies. Measures of pain and disability were the most commonly collected outcomes measures. Two studies collected information on quality of life directly from participants while two studies modelled this information based on the literature. Future economic evaluations of interventions for chronic lower back pain, including pharmacological interventions, should be based on the results of well-conducted RCTs where the measurement of costs and outcomes such as quality of life and quality-adjusted life-years is included in the trial protocol, and which have a follow-up period sufficient to capture meaningful changes in both costs and outcomes. In the absence of RCT data, economic models should be used to estimate future costs and outcomes using robust methods.

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The Cost-Effectiveness of Duloxetine in Chronic Low Back Pain: A US Private Payer Perspective

Abstract: Duloxetine appears to be a cost-effective post-first-line treatment for CLBP compared with all but generic NSAIDs. In subpopulations at risk of NSAID-related AEs, it is particularly cost-effective.

Cited by 27 publications

References 80 publications

Do Value Thresholds for Oncology Drugs Differ from Nononcology Drugs?

Do Value Thresholds for Oncology Drugs Differ from Nononcology Drugs?

NSAIDs for Musculoskeletal Pain Management: Current Perspectives and Novel Strategies to Improve Safety

Pharmacological Management of Chronic Lower Back Pain: A Review of Cost Effectiveness

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