Economic evaluation of ibuprofen/codeine combination versus ibuprofen alone for acute pain treatment in Peru

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Abstract

Objective

The purpose of this study was to analyse two analgesic interventions for acute dental pain from the pharmacoeconomic standpoint:ibuprofen (IBU) versus ibuprofen/codeine combination (IBU/COD).

Methods

A pharmacoeconomic model based on a decision analysis has been used. It represents the probable clinical evolution in a 5-day time horizon, applying both alternatives for acute dental pain treatment (IBU alone versus IBU/COD), each one identified according to its effectiveness (number of hours without pain). The cost-effectiveness (C-E) ratio has been calculated to evaluate each option, the ratio with the lowest value being considered most efficient; an incremental C-E analysis of both alternatives enables the determination of the cost necessary to achieve an extra unit of effectiveness. Costs have been calculated from the patient's perspective (society), and all monetary units are expressed in US$ as of 2011.

Results

The C-E ratios for interventions with IBU and IBU/COD were estimated at US$7.23 and US$6.27 respectively. The incremental C-E ratio (ICER) between these two treatments indicates that each unit of difference between both interventions would cost US$5.35; i.e. each hour without pain in a cohort of 100 patients would cost US$5.35. The sensitivity analysis indicates that it is necessary to vary extensively the effectiveness estimates, costs or pain response probabilities to change the direction of the final result, giving statistical robustness to the results of this analysis.

Conclusion

According to the results of this study, intervention with IBU/COD proves to be more cost-effective than IBU. Sensitivity analysis strengthens the trend of the results since a broad range of variable modification would be necessary to balance C-E difference between the two interventions. Differences in demographic and cultural factors for pain perception between countries may threaten the transferability of the results.

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