Cost-effectiveness analysis of entacapone in Parkinson's disease: a Markov process analysis.
OBJECTIVE
The objective of this study was to examine the cost-effectiveness of a complementary treatment with entacapone versus usual care only in patients with Parkinson's disease.


METHODS
The setting for this study was the Netherlands. A Markov process model was constructed to model the average quality-adjusted life years (QALYs) and the costs of both treatments. The model examined a period of 5 years in order to capture the influence of symptom improvement and disease progression. Data for the construction of the model were derived from published literature, including large, multicenter, randomized clinical trials in patients with end-of-dose motor fluctuations. Costs were obtained from published sources.


RESULTS
The results of the baseline analysis showed that the use of entacapone as complementary therapy in Parkinson's disease slightly decreased the total average discounted costs from NLG 111,317 to NLG 110,038, while effectiveness increased from 2.42 to 2.56 QALYs (a 6% increase). In addition, entacapone substantially increased time without severe fluctuations by 0.63 years. Sensitivity analyses confirmed the robustness of these findings.


CONCLUSIONS
The study shows that entacapone is a cost-effective treatment in patients with Parkinson's disease: entacapone yields higher effectiveness in terms of both effectiveness measures (time without severe fluctuations and QALYs), while costs remain quite similar to those for usual care. The additional drug costs for entacapone are offset by reductions in other costs.
Nuijten
M J
MJ
MEDTAP International, Dorpsstraat 75, 1526 LG Jisp, Amsterdam, The Netherlands. nuijtenmedtap@compuserve.com
van Iperen
P
P
Palmer
C
C
van Hilten
B J
BJ
Snyder
E
E
D000368:Aged; D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use*; D002396:Catechols / Q000191:economics / Q000627:therapeutic use*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D017850:Economics, Pharmaceutical; D004526:Efficiency; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007980:Levodopa / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009426:Netherlands; D009570:Nitriles; D010300:Parkinson Disease / Q000188:drug therapy* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D002396:Catechols; D009570:Nitriles; D007980:Levodopa; C071192:entacapone