This study aimed to estimate the cost-effectiveness of pregabalin treatment for neuropathic pain.
Design:Long-term simulations based on state transition models.
Methods:We examined the cost-effectiveness of pregabalin for treatment of three common peripheral neuropathic pains, postherpetic neuralgia(PHN), painful diabetic peripheral neuropathy(DPN), and radiculopathy, using the incremental cost-effectiveness ratio(ICER). We used quality-adjusted life years(QALYs)as an index of effectiveness, and also estimated medical costs. For PHN and DPN, we constructed state transition models comprising two states, with and without pregabalin treatment, and performed 52-week simulations. The pain scores reported in Japanese phaseIII studies were used to set patients' weekly pain scores. The results of utility surveys conducted overseas were used as utility scores, while values randomly sampled from probability distributions were used to set weekly pain scores and drop-out rates. In base-case analyses, we performed 1000 1st-order Monte Carlo simulations using 1000 values randomly sampled from probability distributions, and calculated QALYs and medical costs for 52 weeks for each group. For radiculopathy, the ICER was calculated from changes in QALYs for 12 weeks reported overseas and medical costs estimated separately for the identical period.
Results:The ICERs for PHN, DPN, and radiculopathy were 1,116,886 Yen/QALY, 1,100,420 Yen/QALY, and 1,095,943 Yen/QALY, respectively, which were well below the upper limits of ICER ranges for treatments considered cost-effective. There were no cases in which ICERs obtained from scenario and sensitivity analyses differed significantly.
Conclusion:Pregabalin was shown to be cost-effective treatment for neuropathic pain.

A 16-year-old girl with aortitis syndrome under treatment with a low dose of prednisolone was admitted because of severe headache and intermittent claudication. Angiography revealed diffuse stenosis of the thoracoabdominal aorta and the bilateral renal arteries. Extra-anatomical bypass grafting from the ascending to the abdominal aorta was first made with a 14mm woven Dacron graft through a midline sternolaparotomy. Bilateral renal arteries were difficult to dissect due to periarterial adhesion. Bypass grafting for the left renal artery could be performed with a 5mm external velour wrap-knit Dacron graft (Sauvage, Bionit); however, the right renal artery was so thin that bypass was made with a 4mm EPTFE graft which was demonstrated to be occluded by follow-up angiography 3 years after surgery. The postoperative course has been uneventful and she has been free from symptoms up to now. The good long-term function of the bypass graft from the ascending aorta holds promise for diffuse coarctation of the thoracoabdominal aorta due to aortitis syndrome.

Detection of the coronary artery is usually an easy procedure in the coronary artery surgery. However in cases with an intra-muscular and/or intra-fat coronary artery, it requires special skill and experience. Dissection of epicardial adipose tissue and/or muscle along the epicardial groove is a common procedure to reach such coronary artery in conventional CABG (C-CABG). Recently, off-pump CABG (OPCAB) has become a standard operation, and detection of such a coronary artery is difficult under the beating heart. Then conversion to the C-CABG becomes necessary to avoid ventricular rupture. We report a new procedure to easily detect such a coronary artery in OPCAB, using an ultrasonic Fowmeter used in neurosurgery. Because the tip of the probe is small (2mm in diameter) and flexible, its handling is quite similar to that of the micro-blade knife. Furthermore, audiable Doppler flow sound allows detection and dissection of the coronary artery without looking away from the operative field to check the coronary flow. In our case, use of the instrument enabled us to detect the anterior descending branch of the left coronary artery which was very deep in adipose tissue. Therefore, application of this ultrasound instrument is beneficial in OPCAB with an intra-muscular and/or intra-fat coronary artery.