Neuropathic Pain: Quality-of-Life Impact, Costs and Cost Effectiveness of Therap

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Pharmacoeconomics. 2009;27(2):95-112. doi: 10.2165/00019053-200927020-00002.

Neuropathic Pain: Quality-of-Life Impact, Costs and Cost Effectiveness of

Therapy.

O'Connor AB.

Department of Medicine, University of Rochester School of Medicine and

Dentistry, New York, USA.

A number of different diseases or injuries can damage the central or peripheral

nervous system and produce neuropathic pain (NP), which seems to be more

difficult to treat than many other types of chronic pain. As a group, patients

with NP have greater medical co-morbidity burden than age- and sex-adjusted

controls, which makes determining the humanistic and economic burden

attributable to NP challenging.

Health-related quality of life (HR-QOL) is substantially impaired among patients

with NP. Patients describe pain-related interference in multiple HR-QOL and

functional domains, as well as reduced ability to work and reduced mobility due

to their pain. In addition, the spouses of NP patients have been shown to

experience adverse social consequences related to NP.

In randomized controlled trials, several medications have been shown to improve

various measures of HR-QOL. Changes in HR-QOL appear to be tightly linked to

pain relief, but not to the development of adverse effects. However, in

cross-sectional studies, many patients continue to have moderate or severe pain

and markedly impaired HR-QOL, despite taking medications prescribed for NP.

The quality of NP treatment appears to be poor, with few patients receiving

recommended medications in efficacious dosages. The substantial costs to society

of NP derive from direct medical costs, loss of the ability to work, loss of

caregivers' ability to work and possibly greater need for institutionalization

or other living assistance. No single study has measured all of these costs to

society for chronic NP.

The cost effectiveness of various interventions for the treatment or prevention

of different types of NP has been assessed in several different studies. The

most-studied diseases are post-herpetic neuralgia and painful diabetic

neuropathy, for which tricyclic antidepressants (both amitriptyline and

desipramine) have been found to be either cost effective or dominant relative to

other strategies.

Increasing the use of cost-effective therapies such as tricyclic antidepressants

for post-herpetic neuralgia and painful diabetic neuropathy may improve the

HR-QOL of patients and decrease societal costs. Head-to-head clinical trials

comparing NP therapies are needed to help assess the relative clinical efficacy

of treatments, ideally using HR-QOL and utility outcomes.

The full costs to society of NP, including productivity loss costs, have not

been determined for chronic NP. Improved relative efficacy, utility and cost

estimates would facilitate future cost-effectiveness research in NP.