OBJECTIVES : The potentially severe, disabling, and chronic nature of neuropathic pain (PNP) places a large burden on both patients and healthcare systems. Current first line treatment options are effective but are limited by factors such as systemic adverse effects, and slow titration and drug-drug interaction requiring further treatment.

The capsaicin 179mg patch is a European Medicines Agency-licensed treatment for PNP, and a Food and Drug Administration-licensed treatment for the post-herpetic neuralgia (PHN) subtype of PNP. This analysis aimed to evaluate the cost-effectiveness relative to placebo of capsaicin 179mg compared with two other second line treatments for which randomised controlled trials data was available [botulinum toxin-A (BTX-A) and intravenous (IV) lidocaine], in patients with PHN, from a United Kingdom National Health Service (NHS) perspective.

METHODS : A cohort-based Markov model was developed using response states over a 3-year time horizon, accounting for treatment sequencing in clinical practice, without excessive extrapolation of existing data. Response was defined as a ≥30% improvement in Numeric Pain Rating Scale score over a 12-week cycle in line with previous economic modelling on neuropathic pain. Baseline characteristics, treatment response, discontinuation, adverse event frequency and utility values were identified through a systematic literature review. Treatment outcomes were derived from a network meta-analysis. Treatment and health state costs were sourced from published literature, British National Formulary and NHS Drug Tariffs, using a 2019/2020 price year.

RESULTS : Incremental cost-effectiveness ratios for capsaicin 179mg, BTX-A, and IV lidocaine, relative to placebo were: £9,043, £13,309, £12,689 per QALY. Sensitivity analyses showed these results to be relatively stable to variation of key parameters, and most sensitive to health state utility values.

CONCLUSIONS : The capsaicin 179mg was more cost-effective relative to placebo than BTX-A and IV lidocaine in patients with PHN.