Clinical Characteristics, Pharmacotherapy, and Healthcare Resource Use among Patients with Diabetic Neuropathy Newly Prescribed Pregabalin or Gabapentin

Authors


  • Disclosures: This research was funded by Pfizer Inc. Dr. Gore is a Principal Consultant and Kei-Sing Tai is a Principal Statistician at Avalon Health Solutions, Inc., who were paid consultants to Pfizer in connection with the development and execution of both this article and the research it describes. Dr. Gore also owns stock in Pfizer. Dr. Zlateva and Ms. Chandran are employees of Pfizer and own stock in Pfizer. Dr. Leslie was paid an honorarium for his participation in this research and for his review and input to this article by Avalon Health Solutions, Inc. Dr. Leslie has also performed consulting for Kurron Bermuda Ltd.

Address correspondence and reprint requests to: Mugdha Gore, BPharm, PhD, Avalon Health Solutions, Inc., 1518 Walnut St, Suite 1507, Philadelphia, PA 19102, U.S.A. E-mail: mgore@avalonhealthsolutions.com.

Abstract

Objective:  To characterize comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with painful diabetic peripheral neuropathy (pDPN) newly prescribed pregabalin or gabapentin in clinical practice.

Methods:  Using the LifeLink Health Plan Claims Database, patients with pDPN (ICD-9-CM codes 357.2 or 250.6) newly prescribed (index event) gabapentin (n = 1,178; 56.9 ± 10.3 years old) were identified and propensity score-matched with patients initiated on pregabalin (n = 1,178; 56.4 ± 9.8 years old). Comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods.

Results:  Both cohorts were characterized by multiple comorbidities and substantial use of pain-related and adjunctive medications. In the pregabalin cohort, the use of tricyclic antidepressants significantly decreased (16.0% vs. 13.2%) and nonsteroidal anti-inflammatory drugs (30.8% vs. 34.8%), muscle relaxants (19.2% vs. 22.9%), anticonvulsants (14.4% vs. 18.1%), benzodiazepines (22.3% vs. 25.0%), and topical agents (7.0% vs. 9.8%) increased (P < 0.05) in the follow-up period. In the gabapentin cohort, there were significant increases (P < 0.05) in the use of short-acting (55.4% vs. 61.2%) and long-acting (9.4% to 12.8%) opioids, serotonin–norepinephrine re-uptake inhibitors (14.2% vs. 16.7%), anticonvulsants (7.1% vs. 19.2%), benzodiazepines (19.1% vs. 24.3%), sedative/hypnotics (14.9% vs. 18.0%), and tramadol (13.3% vs. 16.8%). There were significant increases (P < 0.05) in pharmacy, outpatient, and total costs in both cohorts and in costs of physician office visits in the gabapentin cohort. There was no difference in postindex median total costs between the pregabalin and gabapentin cohorts ($16,137 vs. $15,766).

Conclusions:  Patients with pDPN prescribed pregabalin and gabapentin had a substantial comorbidity and pain medication burden. Although healthcare costs increased in both groups, the increase in pain medication burden was higher in the gabapentin group. Direct medical costs were similar for both groups. Given the human and economic burden of pDPN, future research may benefit from a focus on efficacy parameters to further differentiate treatment options.

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