Identification of patients with painful diabetic peripheral neuropathy who have a favorable cost profile with pregabalin treatment

Abstract

Objective: To characterize patient populations with favorable costs after the initiation of pregabalin for the treatment of painful diabetic peripheral neuropathy (pDPN) relative to duloxetine, gabapentin, and amitriptyline.

Methods: Patients were identified from MarketScan having ≥ 1 claim for pDPN (ICD-9-CM codes 250.6 or 357.2) within 60 days of first prescription (index) for pregabalin, duloxetine, gabapentin, or amitriptyline in 2008 and continuous enrollment 12 months pre- and postindex. Pregabalin patients were propensity-score-matched to each comparator. Using cutoff values ≥ 80% proportion of days covered (PDC) and ≥ 65 years for age, pre- to postindex changes in healthcare costs were estimated for pregabalin vs. comparators.

Results: Of 987 patients initiated on pregabalin, 349 matched to duloxetine; 987 to gabapentin; 276 to amitriptyline. The pre- to postindex changes in total healthcare costs were similar between cohorts: $3272 with pregabalin vs. $2290 with duloxetine (P = 0.5280); $3687 with pregabalin vs. $5498 with amitriptyline (P = 0.5863); $3869 with pregabalin vs. $4106 with gabapentin (P = 0.8303). For the high-age/high-PDC population, the pre- to postindex differences in mean total costs were significantly lower with pregabalin (P < 0.001) relative to comparators ($3573 vs. $8288 for duloxetine; $1423 vs. $3167 for gabapentin; $2285 vs. $6160 for amitriptyline).

Conclusions: The association of lower total costs among older individuals with pDPN who maintain high adherence to pregabalin therapy relative to key comparators suggests a pharmacoeconomic advantage of pregabalin in this population combined with a need for strategies promoting adherence.

Keywords: adherence; diabetic neuropathy; healthcare costs; painful.