JAMA Netw Open

Which fibromyalgia drug offers the best value for moderate to severe disease?

February 5, 2026

A model-based cost-effectiveness analysis found that duloxetine 120 mg provided greater quality-adjusted life-years (QALYs) than amitriptyline with lower lifetime costs when indirect costs were included. From a societal perspective, pregabalin 450 mg also demonstrated lower costs and greater QALYs than amitriptyline, though it was dominated by duloxetine 120 mg. Other regimens—including lower doses of pregabalin and duloxetine, and both milnacipran doses—were less effective and more expensive than amitriptyline.

Clinical takeaway: For moderate to severe fibromyalgia, duloxetine 120 mg offers the strongest value across payer and societal perspectives; consider pregabalin 450 mg when indirect costs are a key concern.

Source:

Downen SS, et al. (2026, February 2). JAMA Netw Open. Cost-Effectiveness of Pregabalin, Duloxetine, and Milnacipran vs Amitriptyline for Moderate to Severe Fibromyalgia. https://pubmed.ncbi.nlm.nih.gov/41632472/