OBJECTIVES : This research estimates the population pharmacoeconomic benefits of over-the-counter (OTC) topical diclofenac in the treatment of mild-to-moderate acute pain or injury (acute indication) and short-term pain associated with chronic conditions (chronic indication) in Germany. Topical diclofenac is an effective analgesic treatment, and OTC status allows first-line access without consuming constrained healthcare resources.

METHODS : The analysis compares topical diclofenac OTC as first-line treatment with an indication-specific mixture of alternative OTC treatments (Topical Ibuprofen, comfrey-based topical, heatwraps, Systemic Ibuprofen, or other Systemic OTC). Proportions of patients using alternative OTC treatments for acute and chronic indications were based on market share data and medical opinion. Treatment success rates were sourced from Cochrane reviews. The analysis reports first and second-line pharmacy costs, second-line physician visit costs, work productivity hours lost, and days not at full health. Reduced health state utilities for days with pain are used to calculate quality-adjusted life years (QALYs).

RESULTS : There were 2,733,297 acute and 4,151,199 chronic indication uses of topical diclofenac OTC in Germany in 2018. The topical diclofenac OTC vs. alternative OTC mixture first-line treatment comparisons in the acute setting showed cost savings (€6,760,337) and provided an additional 1,864.6 QALYs. The chronic indication showed a 4.9% increase in costs (€10,383,830) but provided an additional 1,724.1 QALYs. For the both acute and chronic indications topical diclofenac OTC was associated with fewer work productivity hours lost, days not at full health, and physician visits.

CONCLUSIONS : Use of topical diclofenac OTC vs. alternate OTC treatment mixtures as first-line treatment in Germany results in either cost savings (acute indication) or a relatively low incremental cost for the number of additional QALYs generated, with work productivity benefits and reduced use of healthcare resources.