Pregabalin (Lyrica®) is cost-effective over Gabapentin (Neurontin®) as a First-Line Treatment for Neuropathic Pain (NeP) Management after Spinal Cord Injury (SCI)

Background: Neuropathic pain (NeP) afflicts many spinal cord injury (SCI) patients. Pregabalin is indicated for management of NeP in the USA and is the first-line of treatment in UK. Although gabapentin is not indicated for NeP, it is the most widely used first-line of treatment for NeP in the USA. This study evaluates cost-effectiveness of pregabalin and gabapentin in management of NeP from the societal perspective.

Methods: We have used a Markov model to simulate costs and effectiveness for 1,000 patients treated with placebo, pregabalin and gabapentin over a 5-year period with a monthly cycle. Transition probabilities for placebo and pregabalin were estimated based on a double-blind, randomized controlled trial. High-quality clinical data for gabapentin effectiveness is not available and thus transition probabilities for gabapentin were calculated from published literature listing gabapentin-refractory NeP patients that respond to pregabalin.

Results: Both pregabalin and gabapentin were more effective and less costly compared to the placebo treatment. The quality-adjusted life years (QALYs) for SCI patients with NeP in the placebo, gabapentin and pregabalin groups were 0.49, 0.533, and 0.543, respectively. The incremental cost effectiveness ratio (ICER) for pregabalin versus gabapentin was $104,108 (US$, 2012). One-way sensitivity analysis showed that the model is fairly robust, and that pregabalin is cost-effective with ICERs less than $150,000 in almost all cases tested by one-way sensitivity analysis. The net monetary benefit analysis showed that gabapentin, which dominated placebo treatment, is the best option if willingness to pay is less than $104,108 (per QALY) and pregabalin is the best above this ICER value.

Conclusions: Pregabalin is cost-effective as a first-line treatment for SCI-associated NeP in the USA.