Background & Aims

Diabetic neuropathic pain is one of the largest health burdens in countries around the globe. Pain specialists had developed a multimodal approach to chronic pain management in the 1980ies that leads to major improvements in functioning and quality of life and reduced work absenteeism. Multimodal pain management is offered by specialized clinics in some countries, but is not generally available to the patient population at large. This is partly due to the consideration that it may be too expensive. Led by the European Brain Council within the Value of Treatment (VoT) initiative, VoT Chronic Pain analysed to what extent the cost of multimodal management is offset by savings in direct and indirect cost of continuing the current standard of care.
The aim of this study is to assess the cost-effectiveness of chronic pain management in Germany with and without multimodal treatment in patients with diabetic neuropathic pain.

Methods

This cost-effectiveness analysis (CEA) is performed for a cohort of patients entering Step 3 of pain management of diabetic neuropathic pain. Data sources used include clinical trials, other published literature, and specific German epidemiology and costing data, and clinical expert opinion. The model includes relevant economic measures such as resource utilization patterns associated with outpatient and inpatient care for the treatment of diabetic neuropathic pain. This analysis is conducted according to the country-specific guidelines for economic evaluations and budget impact analyses. This CEA is based on a 5-year time horizon with discount rate of 3% for clinical and economic outcomes.
A Markov model is constructed for chronic pain management in Germany for diabetic neuropathic pain. The Markov health states are corresponding with Steps 3 to 5 in a pain management flowchart including an absorption state for refractory patients.

Results

Using Germany as a model country, standard of care was estimated to yield 3.56 QALYs over 5 years at a cost of € 4,997 per patient. Multimodal management was estimated to yield 3.81 QALYs at € 4,824 cost in patients with diabetic neuropathic pain. Thus a broader availability of multimodal management and self-management is predicted to yield an improvement by 0.25 QALY with a saving of € 173 per patient. Extensive sensitivity analyses and scenario analyses confirmed that the base case cost-effectiveness estimate was robust. One-way sensitivity analyses showed that the model was most sensitive to proportion of patients switching to Multimodal management.

Conclusions

In terms of health economic modelling, multimodal pain management may be called a “dominant strategy” compared to pain management without multimodal treatment as it leads to both cost savings and QALY gain. Therefore, the inclusion of multimodal treatment is cost-effective for German society. Hence, European guidelines should recommend the multimodal approach as first line treatment for diabetic neuropathic pain, for the benefit of both the people affected and the German economy at large.

References

Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2012). Nationale VersorgungsLeitlinie Neuropathie bei Diabetes imErwachsenenalter – Leitlinienreport, 1. Auflage. Version 3. 2012. Available from: www.dm-neuropathie.versorgungsleitlinien.de; [cited: tt.mm.jjjj]; DOI: 10.6101/AZQ/000316

Tesfaye S, Brill S, Eerdekens M, Labrador MM, Petersen G, de Rooij Peek A, Reta A, Ryan D, Schaper N, Tölle T, Truini A, Ziegler D (2023) Diagnosis, management and impact of painful diabetic peripheral neuropathy: A patient survey in four European countries. J Diabetes Complications. 2023 Apr;37(4):108417. doi: 10.1016/j.jdiacomp.2023.108417. Epub 2023 Feb 10. PMID: 36905720

Presenting Author

Mark Nuijten

Poster Authors

mark nuijten

MD, PhD.

a2m

Lead Author

E-mail

Andrea Truini

University Sapienza

Lead Author

E-mail

Geert dom prof. dr.

Antwerp University, Belgium

Lead Author

E-mail

elena ENAX-KRUMOVA

Prof Dr,

University Hospital Bergmannsheil Bochum, Germany

Lead Author

E-mail

Dieyenaba FAYE

European Brain Council

Lead Author

E-mail

Winfried HÄUSER

Prof. Dr.

Psychosomatic Medicine and Psychotherapy, Technical University of Munich

Lead Author

E-mail

Levent Ertu?rul INAN

Prof. Dr

Health Sciences University, Ankara SUAM, Turkey

Lead Author

E-mail

Ulrike KAISER

PhD Dr

University Hospital Schleswig-Holstein, Clinic for Anesthesiology / Intensive Care Medicine, Lübeck

Lead Author

E-mail

Serge PERROT

MD

Centre de la Douleur, Hôpital Cochin, Université de Paris

Lead Author

E-mail

Gudula PETERSEN

Dr

Grunenthal, Germany

Lead Author

E-mail

Frank PETZKE

Prof. Dr

Department of Anesthesiology, University Hospital Medical Center, Gottingen, Germany

Lead Author

E-mail

Martin RAKUSA

Prof. Dr.

University Medical Center Maribor, Slovenia

Lead Author

E-mail

Deirdre RYAN

Pain Alliance Europe

Lead Author

E-mail

Rolf-Detlef Treede

Heidelberg University

Lead Author

E-mail

Topics

  • Other