ADJUNCTIVE THERAPY WITH PREGABALIN IN GENERALIZED ANXIETY DISORDER PATIENTS WITH PARTIAL RESPONSE TO SSRI TREATMENT- A COST-CONSEQUENCES ANALYSIS IN MEDICAL PRACTICE IN SPAIN

Author(s)

Carrasco JL1;Olivares JM2;Alvarez E3;Pérez M4;López-Gómez V4, Rejas J*5 1Department of Psychiatry, Hospital Clínico San Carlos, Madrid, Spain, 2Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo, Spain, 3Department of Psychiatry, Hospital de la Santa Creu i San Pau, Barcelona, Spain, 4Pfizer S.L.U., Alcobendas, Madrid, Spain, 5Pfizer S.L.U., Alcobendas/Madrid, Spain

OBJECTIVES: To compare the effect of adjunctive therapy with pregabalin versus usual care (UC) on healthcare costs and clinical and patients consequences in Generalized Anxiety Disorder (GAD) subjects with partial response (PR) to previous SSRI course in medical practice in Spain. METHODS: Post-hoc analysis of patients with PR to SSRI monotherapy enrolled in a prospective 6-month naturalistic study. PR was defined as a Clinical-Global-Impression scale score >3 and insufficient response with persistence of anxiety symptoms >16 in the Hamilton-Anxiety scale. Two groups (based on psychiatrist judgment) were analyzed 1) adjunctive therapy (AT) with pregabalin (150-600 mg/day) to existing therapy; or 2) usual care (switching to a different SSRI or adding another anxiolytic different than pregabalin). Costs estimation used year-2009 prices for GAD related healthcare resources utilization. Consequences were a health profile based on the combination of psychiatrist-based-measurements [HAM-A, CGI and Montgomery-Asberg-Depression-Rating (MADRS) scales], and patient-reported-outcomes [sleep (MOS-sleep), disability (WHO-DAAS II) and quality-of-life/quality-adjusted-life-year gain (EQ-5D)]. Changes in  both healthcare costs and scale scores were compared separately at end-of-trial visit by a general-linear-model with covariates. RESULTS: Four-hundred-eighty-six newly prescribed pregabalin and 239 UC GAD patients [mean (SD) HAM-A 26.7 (6.9) and CGI 4.1 (0.5)] were analyzed. Adding pregabalin was associated with significantly higher mean (95% CI) score reductions vs. UC in HAM-A [-14.9(-15.6;-14.2) vs. -11.2(-12.2;-10.2), p<0.001] and MADRS [-11.6(-12.2;-10.9) vs. -7.8(-8.7;-6.8), p<0.001]. Changes in all patient-reported-outcomes favored significantly patients receiving pregabalin, including QALY gain; 0.13(0.12;0.14) vs. 0.09(0.07;0.10), p<0.001. Healthcare costs were significantly reduced in both cohorts yielding similar 6-month costs; €1543 (1375;1711) UC and €1497 (1380;1614) pregabalin, p=0.661. The effect of sex on costs and consequences were negligible. CONCLUSIONS: In medical practice, GAD patients with PR to SSRI experienced greater consequences improvements with adjunctive therapy with pregabalin versus UC, without increasing healthcare cost. The effect of pregabalin was independent of patient gender.

Conference/Value in Health Info

2013-11, ISPOR Europe 2013, The Convention Centre Dublin

Value in Health, Vol. 16, No. 7 (November 2013)

Code

PMH32

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Mental Health

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