Objectives
Postherpetic neuralgia (PHN) is the most common complication of herpes zoster. Topical 5% lidocaine medicated plaster has been recommended as the first-line treatment for peripheral localized neuropathic pain, but cost-effectiveness (CE) assessment compared to systemic pregabalin in China was unclear. This study was to conduct a CE analysis for 5% lidocaine plaster versus pregabalin in relieving postherpetic neuralgia, to provide a reference for clinical practice and reimbursement policy making for treatment of PNH in China.
Methods
Markov model was built according to PHN disease characteristics. The efficacy data were extracted from a RCT conducted in China, the transition probability, utility value and medical cost of each state in the model were collected through a systematic review of literature and public databases. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Sensitivity analysis was conducted to confirm the robustness of the model.
Results
In base case analysis, treatment of 6 months period by pregabalin and lidocaine plaster led to a mean QALY gain of 0.34012 and 0.41968, and mean incremental costs of RMB ¥5,720 and ¥14,314. The ICER of treatment by 5% lidocaine plaster was ¥108,014, which is less than 2 times GDP per capita in China (per-capita GDP in 2018 was ¥64,644). Monte Carlo simulation resulted in the estimate of 90% probability that the 5% lidocaine plaster treatment was cost-effective.
Conclusions
In treatment of PHN, 5% lidocaine plaster has better remission effect, but more treatment costs compared to pregabalin. According to the CE threshold of three times the per-capita GDP per QALY gained, the 5% lidocaine plaster treatment was cost effective compared to pregabalin in China.
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