OBJECTIVES: Chronic low back pain (CLBP) is affecting functional disability and impaired quality of life. Majority are treated with anti-depressants and anticonvulsants. However, limited evidence outlining their cost effectiveness in terms of cost per quality-adjusted life-year (QALY) is available from Indian perspective. Objective of this study is to do Cost-effectiveness analysis (CUA) of pregabalin as compared with gabapentin in CLBP.

METHODS: Decision tree was created to assess CUA of pregabalin vs gabapentin during first 3 months of therapy for moderate to severe CLBP over a 12-month time horizon. Main outcome was cost per QALY using incremental cost-effectiveness ratio (ICER). Costs were estimated using societal perspective. Costs of medication were calculated from different websites. We used a threshold of 40000 INR as a willingness to pay (WTP) for the intervention. Transition probabilities of efficacy (30% pain reduction), adverse events (AEs), withdrawal and discontinuation rates were estimated via a meta-analysis. Treatment specific utilities and resource utilisation for management of CLBP were estimated from literature

RESULTS: Poor pain relief assigned a utility value of 0.50. Base case analysis showed that pregabalin is cost effective (884.45 INR/0.70 QALY) than gabapentin. ICER of pregabalin over gabapentin was found to be 2044 INR/QALY. Pregabalin has more probability and Net monetary benefit value at different levels of WTP than gabapentin. Form probabilistic sensitivity analysis its revealed that Probabilities of adherence, discontinuation, Adverse events of pregabalin were majorly affecting the expected values of pregabalin as cost effective strategy.

CONCLUSIONS: This CUA study finds that pregabalin is the more cost effective intervention than gabapention for the management of chronic low back pain.