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Retrospective Evaluation of Clinical Characteristics, Pharmacotherapy and Healthcare Resource Use among Patients Prescribed Pregabalin or Duloxetine for Diabetic Peripheral Neuropathy in Usual Care
Author(s) -
Gore Mugdha,
Zlateva Gergana,
Tai KeiSing,
Chandran Arthi Bala,
Leslie Douglas
Publication year - 2010
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2010.00415.x
Subject(s) - duloxetine , pregabalin , medicine , pharmacotherapy , pharmacy , anesthesia , retrospective cohort study , alternative medicine , family medicine , pathology
Abstract Objective: To evaluate treatment patterns and costs among patients with painful diabetic peripheral neuropathy (pDPN) newly prescribed pregabalin or duloxetine in usual care settings. Methods: Using the PharMetrics ® Database, patients with pDPN (ICD‐9‐CM codes 357.2 or 250.6x) newly prescribed pregabalin or duloxetine were identified. Patients initiated on duloxetine ( n = 713; mean age 55.4 ± 9.5 years) were propensity score‐matched with patients initiated on pregabalin ( n = 713; mean age 56.3 ± 9.3 years). Prevalence of comorbidities, pain‐related pharmacotherapy and healthcare resource use/costs (pharmacy, outpatient, inpatient, total) were examined during the 12 months preceding (pre‐index) and following (follow‐up) the date of the first pregabalin or duloxetine prescription. Results: Both cohorts had multiple comorbidities and a substantial pain medication burden. Among pregabalin patients, use of other anticonvulsants (35.6% vs. 24.7%) and tricyclic antidepressants significantly decreased (18.2% vs. 13.7%) and serotonin‐norepinephrine reuptake inhibitors (SNRIs) increased (7.9 % vs. 12.9%) in the follow‐up period; all P values < 0.05. Among duloxetine patients, use of other SNRIs (8.7% vs. 5.2%) and selective serotonin reuptake inhibitors decreased significantly (32.1% vs. 18.9%) in the follow‐up period, but there were increases for anticonvulsants (42.1% vs. 48.4%), benzodiazepines (25.5% vs. 32%), and sedative/hypnotics (22.6% vs. 25.8%); all P values < 0.05. Among pregabalin and duloxetine patients there were increases ( P < 0.05) in pharmacy, outpatient, and total healthcare costs from the pre‐index to the follow‐up period. Total medication costs in the follow‐up period were significantly higher for duloxetine (median $6,763 [IQR $3,970–$10,914]) relative to pregabalin (median $6,059 [IQR $3,277–$9,865]); P = 0.0017. Conclusions: Patients with pDPN prescribed pregabalin and duloxetine were characterized by a substantial comorbidity and pain medication burden. Although there were no differences in total healthcare costs, medication costs were significantly higher in the duloxetine cohort relative to the pregabalin cohort.