Abstract
A number of different diseases or injuries can damage the central or peripheral nervous system and produce neuropathic pain (NP), which seems to be more difficult to treat than many other types of chronic pain. As a group, patients with NP have greater medical co-morbidity burden than age- and sex-adjusted controls, which makes determining the humanistic and economic burden attributable to NP challenging.
Health-related quality of life (HR-QOL) is substantially impaired among patients with NP. Patients describe pain-related interference in multiple HR-QOL and functional domains, as well as reduced ability to work and reduced mobility due to their pain. In addition, the spouses of NP patients have been shown to experience adverse social consequences related to NP. In randomized controlled trials, several medications have been shown to improve various measures of HR-QOL. Changes in HR-QOL appear to be tightly linked to pain relief, but not to the development of adverse effects. However, in cross-sectional studies, many patients continue to have moderate or severe pain and markedly impaired HR-QOL, despite taking medications prescribed for NP. The quality of NP treatment appears to be poor, with few patients receiving recommended medications in efficacious dosages.
The substantial costs to society of NP derive from direct medical costs, loss of the ability to work, loss of caregivers’ ability to work and possibly greater need for institutionalization or other living assistance. No single study has measured all of these costs to society for chronic NP. The cost effectiveness of various interventions for the treatment or prevention of different types of NP has been assessed in several different studies. The most-studied diseases are post-herpetic neuralgia and painful diabetic neuropathy, for which tricyclic antidepressants (both amitriptyline and desipramine) have been found to be either cost effective or dominant relative to other strategies.
Increasing the use of cost-effective therapies such as tricyclic antidepressants for post-herpetic neuralgia and painful diabetic neuropathy may improve the HR-QOL of patients and decrease societal costs. Head-to-head clinical trials comparing NP therapies are needed to help assess the relative clinical efficacy of treatments, ideally using HR-QOL and utility outcomes. The full costs to society of NP, including productivity loss costs, have not been determined for chronic NP. Improved relative efficacy, utility and cost estimates would facilitate future cost-effectiveness research in NP.
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References
Woolf CJ. Pain: moving from symptom control toward mechanism-specific pharmacological management. Ann Intern Med 2004; 140: 441–51
Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical research purposes. Neurology 2008; 70 (18): 1630–5
Dworkin RH, O’Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007; 132 (3): 237–51
Gore M, Dukes E, Rowbotham DJ, et al. Clinical characteristics and pain management among patients with peripheral neuropathic disorders in general practice settings. Eur J Pain 2007; 11: 652–64
Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147 (7): 478–91
Chou R, Huffman LH, American Pain Society American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med 2007; 147 (7): 505–14
Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician 2007; 10 (1): 7–111
Taylor RS. Epidemiology of refractory neuropathic pain. Pain Pract 2006 Mar; 6 (1): 22–6
Torrance N, Smith BH, Bennett MI, et al. The epidemiology of chronic pain of predominantly neuropathic origin: results from a general population survey. J Pain 2006; 7 (4): 281–9
Torrance N, Smith BH, Watson MC, et al. Medication and treatment use in primary care patients with chronic pain of predominantly neuropathic origin. Fam Pract 2007; 24 (5): 481–5
Gore M, Brandenburg NA, Dukes E, et al. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manage 2005; 30 (4): 374–85
Oster G, Harding G, Dukes E, et al. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain 2005; 6 (6): 356–63
McDermott AM, Toelle TR, Rowbotham DJ, et al. The burden of neuropathic pain: results of a cross-sectional survey. Eur J Pain 2006; 10 (2): 127–35
Tolle T, Xu X, Sadosky AB. Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns. J Diabetes Complications 2006; 20 (1): 26–33
van Seventer R, Sadosky A, Lucero M, et al. A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia. Age Ageing 2006; 35: 132–7
Tolle T, Dukes E, Sadosky A. Patient burden of trigeminal neuralgia: results from a cross-sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract 2006 Sep; 6 (3): 153–60
Gordon A, Choinière M, Collet J-P, et al. The humanistic burden of neuropathic pain in Canada. J Outcomes Res 2006; 10: 23–35
Gore M, Brandenburg NA, Hoffman DL, et al. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J Pain 2006; 7 (12): 892–900
Gálvez R, Marsal C, Vidal J, et al. Cross-sectional evaluation of patient functioning and health-related quality of life in patients with neuropathic pain under standard care conditions. Eur J Pain 2007; 11: 244–55
Smith BH, Torrance N, Bennett MI, et al. Health and quality of life associated with chronic pain of predominantly neuropathic origin in the community. Clin J Pain 2007; 23: 143–9
Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology 2007; 68: 1178–82
Barrett AM, Lucero MA, Le T, et al. Epidemiology, public health burden, and treatment of diabetic peripheral neuropathic pain: a review. Pain Med 2007; 8 Suppl. 2: S50–62
Benbow SJ, Wallymahmed ME, MacFarlane IA. Diabetic peripheral neuropathy and quality of life. Q J Med 1998; 91 (11): 733–7
Atroshi I, Gummesson C, Johnsson R, et al. Symptoms, disability, and quality of life in patients with carpal tunnel syndrome. J Hand Surg (Am) 1999; 24 (2): 398–404
van der Schans CP, Geertzen JH, Schoppen T, et al. Phantom limb pain and health-related quality of life in lower limb amputees. J Pain Symptom Manage 2002; 24 (4): 429–36
Kemler MA, de Vet HC. Health-related quality of life in chronic refractory reflex sympathetic dystrophy (complex regional pain syndrome type I). J Pain Symptom Manage 2000; 20 (1): 68–76
Markarian Y, Wulff EA, Simpson DM. Peripheral neuropathy in HIV disease. AIDS Clin Care 1998; 10 (12): 89–91,93,98
Kong KH, Woon VC, Yang SY. Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors. Arch Phys Med Rehabil 2004; 85 (1): 35–40
Wollaars MM, Post MW, van Asbeck FW, et al. Spinal cord injury pain: the influence of psychological factors and impact on quality of life. Clin J Pain 2007; 23 (5): 383–91
O’Connor AB, Schwid SR, Markman J, et al. Pain associated with multiple sclerosis: systematic review and proposed classification. Pain 2008; 137 (1): 96–111
Haythornthwaite JA, Benrud-Larson LM. Psychological aspects of neuropathic pain. Clin J Pain 2000; 16 (2 Suppl.): S101–5
Haythornthwaite JA, Clark MR, Pappagallo M, et al. Pain coping strategies play a role in the persistence of pain in post-herpetic neuralgia. Pain 2003; 106 (3): 453–60
Sofaer-Bennett B, Walker J, Moore A, et al. The social consequences for older people of neuropathic pain: a qualitative study. Pain Med 2007; 8 (3): 263–70
Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain 2004; 5: 143–9
Lachaine J, Gordon A, Choiliere M, et al. Painful neuropathic disorders: an analysis of the Régie de l’Assurance Maladie du Québec database. Pain Res Manage 2007; 12 (1): 31–7
Atroshi I, Gummesson C, McCabe SJ, et al. SF-6D health utility index in carpal tunnel syndrome. J Hand Surg Eur Vol 2007; 32 (2): 198–202
FDA Center for Drug Evaluation and Research. Approval package for: application number 21–446 medical review(s): 145–63, 182–210 [online]. Available from URL: http://www.fda.gov/cder/foi/nda/2004/021446_Lyrica%20Capsules_medr.PDF [Accessed 2008 Dec 12]
Otto M, Bach FW, Jensen TS, et al. Health-related quality of life and its predictive role for analgesic effect in patients with painful polyneuropathy. Eur J Pain 2007; 11 (5): 572–8
Wernicke JF, Pritchett YL, D’Souza DN, et al. A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain. Neurology 2006; 67 (8): 1411–20
Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia. JAMA 1998; 280: 1837–42
Gilron I, Bailey JM, Tu D, et al. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005; 352: 1324–34
Rice ASC, Maton S, Postherpetic Neuralgia Study Group. Gabapentin in postherpetic neuralgia: a randomized, double blind placebo controlled study. Pain 2001; 94: 215–24
Gordh TE, Stubhaug A, Jensen TS, et al. Gabapentin in traumatic nerve injury pain: a randomized, double-blind, placebo-controlled, cross-over, multi-center study. Pain 2008; 138 (2): 255–66
Serpell MG, Neuropathic Pain Study Group. Gabapentin in neuropathic pain syndromes: a randomised, double-blind, placebo-controlled trial. Pain 2002; 99: 557–66
Dworkin RH, Corbin AE, Young Jr JP, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2003; 60: 1274–83
Sabatowski R, Galvez R, Cherry DA, et al. Pregabalin reduces pain and improves sleep and mood disturbances in patients with postherpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain 2004; 109 (1–2): 26–35
Rosenstock J, Tuchman M, LaMoreaux L, et al. Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial. Pain 2004; 110: 628–38
Lesser H, Sharma U, LaMoreaux L, et al. Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. Neurology 2004; 63: 2104–10
Richter RW, Portenoy R, Sharma U, et al. Relief of painful diabetic peripheral neuropathy with pregabalin: a randomized, placebo-controlled trial. J Pain 2005; 6: 253–60
Vranken JH, Dijkgraaf MGW, Kruis MR, et al. Pregabalin in patients with central neuropathic pain: a randomized, double-blind, placebo-controlled trial of a flexible-dose regimen. Pain 2008; 136 (1–2): 150–7
Watson CPN, Moulin D, Watt-Wilson J, et al. Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Pain 2003; 105: 71–8
Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial. Neurology 2003; 60: 927–34
Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clin Ther 2003; 25: 81–104
Goldstein DJ, Lu Y, Detke MJ, et al. Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain 2005; 116 (1–2): 109–18
Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998; 280: 1831–6
Raskin J, Pritchett YL, Wang F, et al. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med 2005; 6: 346–56
Tolle T, Freynhagen R, Versavel M, et al. Pregabalin for relief of neuropathic pain associated with diabetic neuropathy: a randomized, double-blind study. Eur J Pain 2008; 12: 203–13
Raja SN, Haythornthwaite JA, Pappagallo M, et al. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2002; 59: 1015–21
Rowbotham MC, Twilling L, Davies PS, et al. Oral opioid therapy for chronic peripheral and central neuropathic pain. N Engl J Med 2003; 348: 1223–32
Agarwal S, Polydefkis M, Block B, et al. Transdermal fentanyl reduces pain and improves functional activity in neuropathic pain states. Pain Med 2007; 8 (7): 554–62
Sindrup SH, Gram LF, Skjold T, et al. Clomipramine vs desipramine vs placebo in the treatment of diabetic neuropathy symptoms: a double-blind cross-over study. Br J Clin Pharmacol 1990; 30: 683–91
Freynhagen R, Strojek K, Griesing T, et al. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomized, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain 2005; 115: 254–63
Van Seventer R, Feister HA, Young JP, et al. Efficacy and tolerability of twice-daily pregabalin for treating pain and related sleep interference in postherpetic neuralgia: a 13-week, randomized trial. Curr Med Res Opin 2006; 22 (2): 375–84
Siddall PJ, Cousins MJ, Otte A, et al. Pregabalin in central neuropathic pain associated with spinal cord injury: a placebo-controlled trial. Neurology 2006; 67 (10): 1792–800
Max MB, Kishore-Kumar R, Schafer SC, et al. Efficacy of desipramine in painful diabetic neuropathy: a placebo-controlled trial. Pain 1991; 45: 3–9
Max MB, Lynch SA, Muir J, et al. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992; 326: 1250–6
Deshpande MA, Holden RR, Gilron I. The impact of therapy on quality of life and mood in neuropathic pain: what is the effect of pain reduction? Anesth Analg 2006; 102 (5): 1473–9
Farrar JT, Dworkin RH, Griesing T, et al. Investigation of possible predictors of patient global impression of change response in peripheral neuropathic pain: results of an analysis of 10 trials with pregabalin [poster]. 9th International Conference on the Mechanisms and Treatment of Neuropathic Pain; 2006 Nov 2–4; Southampton, Bermuda
Dukes E, Dworkin R, Collett B, et al. Patients’ willingness to pay for aspects of treatment for peripheral neuropathic pain: a discrete choice experiment [poster]. 9th International Conference on the Mechanisms and Treatment of Neuropathic Pain; 2006 Nov 2–4; Southampton, Bermuda
Hall GC, Carroll D, Parry D, et al. Epidemiology and treatment of neuropathic pain: the UK primary care perspective. Pain 2006; 122 (1–2): 156–62
Meyer-Rosberg K, Kvarnstrom A, Kinnman E, et al. Peripheral neuropathic pain: a multidimensional burden for patients. Eur J Pain 2001; 5 (4): 379–89
Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract 2000; 47 (2): 123–8
Finnerup NB, Otto M, McQuay HJ, et al. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005; 118 (3): 289–305
Gilron I, Watson CP, Cahill CM, et al. Neuropathic pain: a practical guideline for the clinician. CMAJ 2006; 173 (3): 265–75
Attal N, Cruccu G, Haanpaa M, et al. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 2006; 13 (11): 1153–69
Berger A, Dukes EM, Edelsberg J, et al. Use of tricyclic antidepressants in older patients with painful neuropathies. Eur J Clin Pharmacol 2006; 62: 757–64
Berger A, Dukes E, Edelsberg J, et al. Use of tricyclic antidepressants in older patients with diabetic peripheral neuropathy. Clin J Pain 2007; 23 (3): 251–8
Blackwell B, Stefopoulos A, Enders P, et al. Anticholinergic activity of two tricyclic antidepressants. Am J Psychiatry 1978; 135: 722–4
Draganich LF, Zacny J, Klafta J, et al. The effects of antidepressants on obstructed and unobstructed gait in healthy elderly people. J Gerontol A Biol Sci Med Sci 2001; 56: M36–41
American Geriatrics Society. The management of persistent pain in older persons: AGS panel on persistent pain in older persons. J Am Geriatr Soc 2002; 50: S205–24
Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med 1997; 157: 1531–6
Scott FT, Johnson RW, Leedham-Green M, et al. The burden of herpes zoster: a prospective population based study. Vaccine 2006; 24: 1308–14
Davies L, Cossins L, Bowsher D, et al. The cost of treatment for post-herpetic neuralgia in the UK. Pharmacoeconomics 1994; 6 (2): 142–8
Manktelow RT, Binhammer P, Tomat LR, et al. Carpal tunnel syndrome: cross-sectional and outcome study in Ontario workers. J Hand Surg [Am] 2004; 29 (2): 307–17
Insinga RP, Itzler RF, Pellissier JM. Acute/subacute herpes zoster: healthcare resource utilisation and costs in a group of US health plans. Pharmacoeconomics 2007; 25 (2): 155–69
Dworkin RH, White R, O’Connor AB, et al. Health care costs of acute and chronic pain associated with a diagnosis of herpes zoster. J Am Geriatr Soc 2007; 55: 1168–75
Rodriguez MJ, Garcia AJ. A registry of the aetiology and costs of neuropathic pain in pain clinics: results of the registry of aetiologies and costs (REC) in neuropathic pain disorders study. Clin Drug Invest 2007; 27 (11): 771–82
Argoff CE. The coexistence of neuropathic pain, sleep, and psychiatric disorders: a novel treatment approach. Clin J Pain 2007; 23: 15–2
Gordois A, Scuffham P, Shearer A, et al. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care 2003; 26 (6): 1790–5
Le TK, Able SL, Lage MJ. Resource use among patients with diabetes, diabetic neuropathy, or diabetes with depression. Cost Eff Resour Alloc 2006; 4: 18
Bitar G, Alexandrides J, Missirian R, et al. Carpal tunnel release in the United States and Sweden: reimbursement patterns, cost for treatment, and return to work. Plast Reconstr Surg 2002; 109 (5): 1574–8
Foley M, Silverstein B, Polissar N. The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington state. Am J Ind Med 2007; 50 (3): 155–72
Cepeda MS, Farrar JT. Economic evaluation of oral treatments for neuropathic pain. J Pain 2006; 7 (2): 119–28
Tarride JE, Gordon A, Vera-Llonch M, et al. Cost-effectiveness of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia: a Canadian perspective. Clin Ther 2006; 28 (11): 1922–34
Rodriguez MJ. Cost-effectiveness analysis of pregabalin versus gabapentin in the management of neuropathic pain due to diabetic polyneuropathy or post-herpetic neuralgia. Curr Med Res Opin 2007; 23 (10): 2585–96
O’Connor AB, Noyes K, Holloway RG. A cost-effectiveness comparison of desipramine, gabapentin, and pregabalin for treating postherpetic neuralgia. J Am Geriatr Soc 2007; 55 (8): 1176–84
Smith KJ, Roberts MS. Sequential medication strategies for postherpetic neuralgia: a cost-effectiveness analysis. J Pain 2007; 8: 396–404
O’Connor AB. Re: Sequential medication strategies for postherpetic neuralgia: a cost-effectiveness analysis. J Pain 2007; 8 (8): 674–6
Dakin H, Nuijten M, Liedgens H, et al. Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for postherpetic neuralgia in the United Kingdom. Clin Ther 2007; 29: 1491–507
Wu EQ, Birnbaum HG, Mareva MN, et al. Cost-effectiveness of duloxetine versus routine treatment for U.S. patients with diabetic peripheral neuropathic pain. J Pain 2006; 7 (6): 399–407
O’Connor AB. Cost-effectiveness of duloxetine versus routine treatment for U.S. patients with diabetic peripheral neuropathic pain. J Pain 2006; 7 (11): 867
Beard SM, McCrink L, Le TK, et al. Cost-effectiveness of duloxetine in the treatment of diabetic peripheral neuropathic pain in the UK. Curr Med Res 2008; 24 (2): 385–99
O’Connor AB, Noyes K, Holloway RG. A cost-utility comparison of four first-line medications in painful diabetic neuropathy. Pharmacoeconomics 2008; 26 (12): 1045–64
Bell CM, Urbach DR, Ray JG, et al. Bias in published cost effectiveness studies: systematic review. BMJ 2006; 332 (7543): 699–703
Korthals-de Bos IB, Gerritsen AA, van Tulder MW, et al. Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial. BMC Musculoskelet Disord 2006; 7: 86
Chung KC, Walters MR, Greenfield ML, et al. Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis. Plast Reconstr Surg 1998; 102 (4): 1089–99
Saw NL, Jones S, Shepstone L, et al. Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial. J Hand Surg [Br] 2003; 28 (5): 444–9
Lorgelly PK, Dias JJ, Bradley MJ, et al. Carpal tunnel syndrome, the search for a cost-effective surgical intervention: a randomised controlled trial. Ann R Coll Surg Engl 2005; 87 (1): 36–40
Pollock BE, Ecker RD. A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain 2005; 21: 317–22
Mekhail NA, Aeschbach A, Stanton-Hicks M. Cost benefit analysis of neurostimulation for chronic pain. Clin J Pain 2004; 20 (6): 462–8
Blond S, Buisset N, Dam Hieu P, et al. Cost-benefit evaluation of spinal cord stimulation treatment for failed back surgery syndrome patients. Neurochirugie 2004; 50 (4): 443–53
North R, Shipley J, Prager J, et al. Practice parameters for the use of spinal cord stimulation in the treatment of chronic neuropathic pain. Pain Med 2007; Suppl. 4: S200–75
Kemler MA, Furnée CA. Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy. Neurology 2002; 59 (8): 1203–9
Cruccu G, Aziz TZ, Garcia-Larrea L, et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol 2007; 14: 952–70
Hornberger J, Kumar K, Verhulst E, et al. Rechargable spinal cord stimulation versus nonrechargable system for patients with failed back surgery syndrome: a cost-consequences analysis. Clin J Pain 2008; 24 (3): 244–52
Koulousakis A, Kuchta J, Bayarassou A, et al. Intrathecal opioids for intractable pain syndromes. Acta Neurochir Suppl 2007; 97 (Pt 1): 43–8
Hornberger J, Robertus K. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Ann Intern Med 2006; 145: 317–25
Rothberg MB, Virapongse A, Smith KJ. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Clin Infect Dis 2007; 44: 1280–8
Pellissier JM, Brisson M, Levin MJ. Evaluation of the cost-effectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia. Vaccine 2007; 25: 8326–37
Smith KJ, Roberts MS. Antiviral therapies for herpes zoster infections: are they economically justifiable? Pharmacoeconomics 2000; 18 (2): 95–104
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The author thanks Robert Dworkin, PhD, for his thoughtful comments on the manuscript.
No sources of funding were used to assist in the preparation of this article. Dr O’Connor has received research support, unrelated to the topics discussed in this manuscript, from Endo Pharmaceuticals.
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O’Connor, A.B. Neuropathic Pain. Pharmacoeconomics 27, 95–112 (2009). https://doi.org/10.2165/00019053-200927020-00002
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DOI: https://doi.org/10.2165/00019053-200927020-00002