ECONOMIC EVALUATION OF DIABETIC NEUROPATHY MONOTHERAPY FOLLOWED BY COMBINATION THERAPY TREATMENT

Objective: To summarize the literature evidence towards the efficacy and safety of diabetic neuropathy (DNP) treatments, and to assess the cost-effectiveness among the DNP treatment regimens in Qatar, including the use of combination therapy. Methods: In Phase I, a systematic review of the literature meta-analyses and clinical trials, published until February 2024, was performed. In Phase II, a decision-analytic model, followed up by a 20-year horizon Markov model, was constructed to assess the relative short-term and long-term economic outcomes of DNP treatments from the public Qatari hospital perspective. Results: Duloxetine (DLX) approach, amitriptyline (AMT) approach, and pregabalin (PGB) approach were successful, by achieving 50% pain relief, in 50%, 40%, and 38% of patients, respectively. Over the short term, the 'DLX followed by DLX plus PGB' was the dominant regimen. For the long term, the 'PGB followed by PGB plus AMT' regimen was most cost-effective followed by 'AMT followed by AMT plus PGB'. Oneway and multivariate sensitivity analyses confirmed the robustness of results. Conclusion: The 'DLX followed by DLX plus PGB' regimen was dominant in the short term, while 'PGB followed by PGB plus AMT' was cost-effective on long-term.