A cost-utility analysis of pregabalin versus venlafaxine XR in the treatment of generalized anxiety disorder in Portugal
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RESEARCH
Open Access
A cost-utility analysis of pregabalin versus venlafaxine XR in the treatment of generalized anxiety disorder in Portugal Luís Silva Miguel1*, Nuno Silva Miguel2 and Mónica Inês3
Abstract Background: Generalized anxiety disorder is characterized by excessive anxiety and worry about several events and activities. The estimated 1-year prevalence for adults is around 2% and the lifetime prevalence could reach more than 6%. The disease is associated with reduced quality of life, being comparable to that of major depressive disorder and to chronic illnesses such as diabetes and arthritis, and high consumption of health care resources. Methods: A previously published patient-level simulation cost-utility model was adapted to the Portuguese context in order to evaluate clinical and economic consequences of using pregabalin in place of venlafaxine XR in the treatment of generalized anxiety disorder. The model predicts the evolution of 1,000 patients with generalized anxiety disorder, simulating their pathway in weekly cycles over one year treatment. This is done by setting a pre-treatment Hamilton Anxiety Scale score and projecting the weekly impact of the pharmacotherapy on this score. The model uses clinical data from an 8-week flexible dose direct comparison clinical trial between the two drugs; utility values based on a Spanish study; and Portuguese economic data, being the resource consumption obtained via an expert panel. Results: Pregabalin patients benefited from 0.738 quality adjusted life years while those on venlafaxine XR achieved 0.712. Moreover, the number of weeks with no or minimal anxiety symptoms was estimated to be 12.9 for pregabalin and only 3.8 for venlafaxine XR. Those clinical gains were achieved at the expense of an extra 715€ per patient, implying an incremental cost per quality adjusted life year of 27,199€ and an incremental cost per week with no or minimal symptoms of 79€. Sensitivity analysis shows that results are robust to main assumptions. Conclusions: Assuming a threshold of 30,000€ per quality adjusted life year, pregabalin is cost-effective in comparison with venlafaxine XR in the treatment of generalized anxiety disorder in Portugal.
Background Generalized anxiety disorder (GAD) is mainly characterized by at least six months of excessive anxiety and worry, or apprehensive expectation, about a number of events and activities, with these feelings being difficult to control and occurring more days than not. It is also characterized by symptoms including restlessness, fatigue, impaired concentration, irritability, muscle tension and sleep disturbances [1]. A review on the available epidemiological data about GAD in Europe, that included 15 studies reporting data for 15 countries, concluded that the estimated 1-year * Correspondence: [email protected] 1 Research Centre on the Portuguese Economy (CISEP), Instituto Superior de Economia e Gestão, Technical University of Lisbon, Lisbon, Portugal Full list of author information is available at the end of the article
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