Objective:

To evaluate the cost-effectiveness of duloxetine 120 mg compared to amitriptyline and other FDA-approved fibromyalgia treatments.

Approach:

Key Findings:

• Duloxetine 120 mg generated more QALYs (10.40) compared to amitriptyline (9.99) at a slightly higher lifetime cost ($115,770 vs $115,145).
• The incremental cost-effectiveness ratio for duloxetine 120 mg was $1,536 per QALY.
• Duloxetine 120 mg produced an incremental net monetary benefit of $40,075 at a willingness-to-pay threshold of $100,000 per QALY.
• Pregabalin and milnacipran regimens were economically dominated by duloxetine 120 mg.
• Including indirect costs, duloxetine 120 mg was cost-saving relative to amitriptyline.

Interpretation:

Duloxetine 120 mg offers the greatest economic value for patients with fibromyalgia, emphasizing the need to consider societal costs in treatment decisions.

Limitations:

• The model did not fully capture real-world treatment patterns such as dose adjustments or combination therapy.
• Cost estimates relied on published data that may vary across different practice settings.

Conclusion:

Duloxetine 120 mg is the most cost-effective treatment option for moderate to severe fibromyalgia among the evaluated drugs.

Sources:

• JAMA Network Open
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