Health economic evidence of 5% lidocaine medicated plaster in post-herpetic neuralgia

Abstract

Background: Post-herpetic neuralgia (PHN) is the most common and most debilitating complication of herpes zoster, and involves considerable associated costs.

Objective: This paper presents results from nine health economic studies undertaken in eight European countries that compared lidocaine medicated plaster with gabapentin and/or pregabalin in PHN. It aims to support the increasing need for published cost-effectiveness data for health care decision-making processes in Europe.

Methods: All studies were based on a similar core Markov model with data derived from clinical trials, local Delphi panels, and official national price and tariff lists. The main outcome measure was cost per quality-adjusted life year gained; time without pain or intolerable adverse events was also included as a secondary outcome measure. All studies focused on an elderly population of patients with PHN who had insufficient pain relief with standard analgesics and could not tolerate or had contraindications to tricyclic antidepressants.

Results: Despite considerable differences in many of the variables used, the results showed remarkable similarity and suggested that use of lidocaine medicated plaster offered cost-savings in many of the countries studied, where it proved a highly cost-effective alternative to both gabapentin and pregabalin.

Conclusion: Lidocaine medicated plaster is a cost-effective alternative to gabapentin and pregabalin in the treatment of PHN. These savings are largely the result of the superior safety profile of the lidocaine medicated plaster.

Keywords: cost-effectiveness; lidocaine; plaster; post-herpetic neuralgia; zoster.

Figure 1

Basic decision tree structure for the Markov model. Notes: Lidocaine medicated plaster; versatis®, Grünenthal GmbH, Aachen, Germany. a, discontinue the lidocaine plaster during the run-in phase; b, remain on the lidocaine plaster monotherapy after the run-in phase; c, discontinue the lidocaine plaster during the maintenance phase; d, add in additional medication during the lidocaine plaster maintenance phase; e, cease the lidocaine plaster during the run-in with the lidocaine plaster plus additional medication; f, remain on the lidocaine plaster after the run-in phase of the additional medication; g, discontinue the lidocaine plaster during the maintenance phase with additional treatment. Abbreviations: PHN, post-herpetic neuralgia; M, Markov node.

Figure 2

CE acceptability curve for LMP relative to pregabalin in the UK. Notes: Lidocaine medicated plaster: Versatis®, Grünenthal GmbH, Aachen, Germany. Reproduced with kind permission Springer Science+Business Media. Nuijten M, Hidalgo A, Obradovic M, Liedgens H. Cost-effectiveness of a lidocaine plaster relative to gabapentin and pregabalin in the treatment of postherpetic neuralgia in Spain. Value Health. 2010;13(7):A468. Abbreviations: CE, cost effectiveness; LMP, lidocaine medicated plaster.