OBJECTIVES: Diabetic neuropathy (DNP) is considered one of the common micro-complications secondary to diabetes mellitus, manifested in myriad of symptoms, including loss of sensation, pain, and loss of balance. Several agents are utilized in the management of pain as monotherapies or combination therapies. There are no pharmacoeconomics evaluations in the literature of the economic impact of the monotherapy followed by a combination therapy regimen for DNP treatment. The current study sought to evaluate the short-term and long-term cost-effectiveness of different DNP treatment regimens of monotherapies followed by combination therapies as per current practices in Qatar, including duloxetine, pregabalin, and amitriptyline.

METHODS: A comprehensive simulation-based economic decision-analytic model, followed by a Markov model, was constructed to evaluate the outcomes of using DNP treatments in monotherapy followed by combination from the Qatari healthcare perspective. The short-term economic outcome was cost against achieving 50% pain reduction (success), and the long-term economic outcome was cost against quality-adjusted life years (QALYs). Model inputs were based on literature and available local cost and resource use sources. One-way and multivariate sensitivity analyses were undertaken to confirm model robustness.

RESULTS: Based on short-term outcomes, ‘duloxetine followed by duloxetine plus pregabalin’ was dominant over the other alternatives, whereas ‘amitriptyline followed by amitriptyline plus pregabalin’ exhibited dominance over ‘pregabalin followed by pregabalin plus amitriptyline’. However, in the long-term analysis, the ‘pregabalin followed by pregabalin plus amitriptyline’ regimen demonstrated cost effectiveness over duloxetine and amitriptyline with incremental cost-effectiveness ratios of QAR 363,869 and QAR 9,234, respectively. All model conclusions were robust against model input uncertainties.

CONCLUSIONS: The ‘duloxetine followed by duloxetine plus pregabalin’ regimen was the most cost-effective treatment regimen over the short-term follow up (16 weeks). While on a long-term follow up, the ‘pregabalin followed by pregabalin plus amitriptyline’ regimen generated the highest QALYs and was the most cost-effective option.