Profitable or not? Cannabis as an adjunct treatment for chronic neuropathic pain

A team of researchers from the Universities of California and New York conducted an economic feasibility study to analyze the cost-effectiveness model of cannabis adjuvant drug therapy for chronic peripheral neuropathy.

According to a team of American researchers, smoked cannabis represents a cost-effective and efficient alternative as a complementary treatment for chronic neuropathic pain.

Following the results of a recent meta-analysis that demonstrated the value of medicinal cannabis in the treatment of chronic neuropathic pain, a crippling and difficult-to-manage disease, a team of researchers from the Universities of California and New York conducted an economic feasibility study to analyze the cost-effectiveness model of cannabis adjuvant drug therapy for chronic peripheral neuropathy.

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The article in question appeared in the Journal Cannabis and Cannabinoid Research and is entitled "Cost-effectiveness model for smoked cannabis adjuvant in the treatment of chronic neuropathic pain". Using a computer simulation, the researchers compared the costs of first, second and third line usual care with those managed with smoked cannabis. Efficacy and adverse events were supported by clinical trials from previous studies and the cost of cannabis used in the model was based on the retail market price.

Scientific publications demonstrating the effectiveness of medicinal cannabis in the analgesic treatment of several diseases, including chronic neuropathic pain, are increasingly being published. According to a recent meta-analysis, the analgesic effect of inhaled cannabis is comparable to that of gabapentin. According to the recommendations for the therapeutic management of chronic neuropathic pain, cannabinoids should only be proposed as a third line of action. At the same time, to date, an increasing number of patients are using cannabis for medical reasons. These treatments are at their own expense as current regulations prohibit health plans from covering the costs of medicinal cannabis.

Another important point is that this study would be the first to assess the cost-effectiveness of smoked medicinal cannabis in the treatment of chronic disease using a cost-effectiveness model. Previous studies have evaluated the cost-effectiveness of nabiximols and dronabinol in the treatment of multiple sclerosis. The results of this new analysis could, therefore, have an impact on the management of chronic neuropathic pain.

A new therapeutic strategy on the horizon

According to the criteria established, treatment would be considered cost-effective when the ratio of incremental health costs to incremental health benefits, known as the incremental cost-effectiveness ratio (ICER), is less than the willingness of the provider to pay for these health benefits. Conversely, treatment is considered to be dominated, and categorically unprofitable, when it is less effective, but more costly than an alternative, and largely dominated when there is another alternative treatment to usual care with a lower ICER value. 

Daniele Piomelli, editor and Ph.D. at the University of California at Irvine, said, "As the opioid crisis continues unabated, it is essential to understand whether cannabis could offer a safe, effective and economically rational approach to pain management. This article provides new data to help assess this possibility.”

Depending on the thresholds of the proposed payment provisions, which range from $110,000 to $300,000 per QALY (quality-adjusted life years), this analysis shows the cost-effectiveness of medicinal cannabis for improving second-line treatment of chronic neuropathic pain. Further research is needed to explore the long-term benefits of smoked cannabis and the standardization of its dosage for chronic neuropathic pain.

A Cost-Effectiveness Model for Adjunctive Smoked Cannabis in the Treatment of Chronic Neuropathic Pain

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