A DECISION TREE ESTIMATING TOTAL COST OF CARE USING EXPOSURE-ADJUSTED DISCONTINUATION: CAPSAICIN 8% VERSUS ORAL TREATMENTS FOR PAINFUL DIABETIC NEUROPATHY IN THE UNITED STATES
Author(s)
Jesse Fishman, MSc, PharmD1, Hemant Kalia, MD MPH2, Nathan Schuster, MD3, Lizandra Marcondes, MD, PhD4;
1Averitas, Director HEOR, Morristown, NJ, USA, 2Savya Neuroscience Institute, Rochester, NY, USA, 3UCSD, San Diego, CA, USA, 4Averitas, Morristown, NJ, USA
1Averitas, Director HEOR, Morristown, NJ, USA, 2Savya Neuroscience Institute, Rochester, NY, USA, 3UCSD, San Diego, CA, USA, 4Averitas, Morristown, NJ, USA
OBJECTIVES: To estimate 12-month total cost of care due to discontinuation for topical capsaicin 8% (HCCTS) versus oral PDPN treatments from a US payer perspective as existing PDPN economic models inadequately capture the cost of therapy withdrawal and related medical costs.
METHODS: A decision tree model simulated 1,000 adults initiating PDPN treatment with HCCTS or oral agents (duloxetine, pregabalin, gabapentin, amitriptyline, venlafaxine, topiramate); structurally the tree aligned to capsaicin's three-month (3M) retreatment intervals. Treatment discontinuation rates from 78 trials (~15,092 patients) were converted to 3M probabilities using piecewise exponential hazard functions. Using this, on/off treatment exposure was calculated and monthly drug costs (2025 average sales prices) by multiplying the person-months on treatment. Those discontinuing were assumed off treatment entering an undertreated state PDPN. Utilization rates derived from US PDPN cohort studies medical costs (Emergency Room, inpatient, outpatient, physician visits, diagnostics) were applied to the person-months in the undertreated state. Probabilistic sensitivity analysis (PSA) tested uncertainty across 67+ variables.
RESULTS: HCCTS had the lowest discontinuation probabilities, resulting in 11,857 annual person-months on treatment vs 3,401-9,966 for orals. HCCTS drug costs were $6.72M vs $78K-$688K drug cost for oral agents per 1000 patients annually. Medical costs were lower for capsaicin at $509K vs $7.9M-$29.6M for orals, due to less discontinuation time in the undertreated PDPN state. Annual total costs savings HCCTS vs all orals ranged from $0.7M-$25.7M. The PSA demonstrated cost savings across uncertainty ranges.
CONCLUSIONS: Exposure-adjusted cost modeling using trial reported withdrawals estimated HCCTS on treatment time was up to 3x greater vs orals. HCCTS persistence meant fewer medical costs, offsetting drug acquisition costs to yield annual total cost savings of $0.7M-$25.7M vs PDPN oral alternatives for a cohort of 1,000 patients.
METHODS: A decision tree model simulated 1,000 adults initiating PDPN treatment with HCCTS or oral agents (duloxetine, pregabalin, gabapentin, amitriptyline, venlafaxine, topiramate); structurally the tree aligned to capsaicin's three-month (3M) retreatment intervals. Treatment discontinuation rates from 78 trials (~15,092 patients) were converted to 3M probabilities using piecewise exponential hazard functions. Using this, on/off treatment exposure was calculated and monthly drug costs (2025 average sales prices) by multiplying the person-months on treatment. Those discontinuing were assumed off treatment entering an undertreated state PDPN. Utilization rates derived from US PDPN cohort studies medical costs (Emergency Room, inpatient, outpatient, physician visits, diagnostics) were applied to the person-months in the undertreated state. Probabilistic sensitivity analysis (PSA) tested uncertainty across 67+ variables.
RESULTS: HCCTS had the lowest discontinuation probabilities, resulting in 11,857 annual person-months on treatment vs 3,401-9,966 for orals. HCCTS drug costs were $6.72M vs $78K-$688K drug cost for oral agents per 1000 patients annually. Medical costs were lower for capsaicin at $509K vs $7.9M-$29.6M for orals, due to less discontinuation time in the undertreated PDPN state. Annual total costs savings HCCTS vs all orals ranged from $0.7M-$25.7M. The PSA demonstrated cost savings across uncertainty ranges.
CONCLUSIONS: Exposure-adjusted cost modeling using trial reported withdrawals estimated HCCTS on treatment time was up to 3x greater vs orals. HCCTS persistence meant fewer medical costs, offsetting drug acquisition costs to yield annual total cost savings of $0.7M-$25.7M vs PDPN oral alternatives for a cohort of 1,000 patients.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE326
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)