L’efficacité, le profil de tolérance et l’impact économique de la capsaïcine en patch (Qutenza®), dans la prise en charge des douleurs neuropathiques périphériques (DNP), ont été évalués en conditions de vie réelle.

Une étude de type coût-conséquences a été initiée sur une période maximale de suivi de 24 semaines. L’évaluation des coûts directs a été faite selon les perspectives de l’hôpital et l’Assurance maladie.

Quatre-vingt onze patients avec DNP d’étiologie majoritairement post-chirurgicale (42,9 %) ont été sélectionnés. Une réponse thérapeutique a été observée à 12 et 24 semaines pour 27,9 % et 37,1 % des patients respectivement. Le score mental de qualité de vie SF-36a été amélioré. Un surcoût hospitalier de 154 euros a été mesuré par administration sans impact sur les dépenses médicamenteuses ambulatoires.

Cette étude confirme l’intérêt du Qutenza® pour une faible proportion de patients avec DNP sévères et réfractaires.

The capsaïcine 8% cutaneous patch (Qutenza®) was recently approved for the management of patients with peripheral neuropathic pain (PNP). Considering its limited clinical efficacy data, its improvement of medical benefit was determined to be 5 which was insufficient to support its reimbursement in addition to diagnosis related groups’tarifs. Nevertheless its commercialization was associated with a marked interest considering the unmet therapeutic needs for patients with PNP.

Our objectives were to assess the effectiveness, the safety, and the economic impact of Qutenza® in real-life conditions.

An observational cost-consequences study was launched under the aegis of the Drug Committee of our hospital. Medical charts and prescriptions of all patients who received at least one patch application were analyzed. Effectiveness and safety were assessed after 12-week and 24-week of follow-up. The economic impact was measured within the Hospital and Health Insurance perspective and with limitation to direct costs.

From March 2012 to October 2013, 91 patients (54.3±14.1years; 52.7% of male) received at least one application. The average follow- up duration was 188.3±86.4days. The PNP etiologies were mainly post-surgery (42.9%) and post-traumatology (20.8%). A therapeutic response (decrease of ENS score of least 30%) after 12weeks and 24weeks was observed in 27.9% and 37.1% of patients respectively. The SF-36 mental score was significantly improved. The safety profile was good. The application of the patch resulted in incremental costs of 154 euros per hospital stay without impact on outpatient-prescription drug expenditures.

This study confirms the interest of Qutenza® for heavily pretreated, refractory patients with PNP. The clinical profile of responders has to be further investigated in large observational studies.