Toward a Pharmacoeconomic Model of Neuropathic Pain

Abstract

Pharmacoeconomic analysis is increasingly being used to assist decision makers in getting the biggest "bang for the buck" within cost-constrained health care budgets. The tools and techniques of this science, however, have scarcely been applied to neuropathic pain. To describe the basic principles of pharmacoeconomic analysis and set forth a preliminary pharmacoeconomic model of neuropathic pain. Applying the tools and techniques of pharmacoeconomic analysis to neuropathic pain yields several insights. First, because pain treatment predominantly benefits quality of life, the results of a pharmacoeconomic analysis of neuropathic pain treatment should be expressed in terms of the cost per quality-adjusted life-year (QALY)-gained metric. Second, because pain can fluctuate, a state-transition modeling approach should be used in constructing the pharmacoeconomic model to account for changes in pain status over time, particularly as relates to the effects of treatment. Finally, assessment of typical practice patterns in neuropathic pain suggests that the pharmacoeconomic model should account for multiple rounds of treatment (i.e., first-line therapy, second-line therapy, and so on), primary care to specialty care referral patterns, and differences in costs and outcomes between primary care physicians and pain specialists. Pharmacoeconomic analysis of neuropathic pain treatments can play an influential role in formulary committee deliberations, treatment algorithms, and decision making in the clinical setting. By describing the fundamental concepts and key challenges in this field, it is hoped that this article will represent a useful first step toward a pharmacoeconomic model of neuropathic pain.