Cost effectiveness of treatment of Parkinson's disease with entacapone in the United States.
OBJECTIVE
To determine the cost effectiveness of adjunctive therapy with entacapone versus standard treatment (levodopa) without entacapone for patients in the US with Parkinson's disease (PD) who experience 'off-time' (re-emergence of the symptoms of PD) while receiving levodopa.


METHODS
A Markov model was used to estimate 5-year costs and effectiveness of standard treatment with and without entacapone.


METHODS
Probabilities, unit costs, resource utilisation data and utilities were obtained from published literature, clinical trial reports, a national database, and clinical experts. PD disability was measured using the daily proportion of off-time and Hoehn and Yahr scale scores. The analysis measured costs from a societal and third-party payer perspective, and effectiveness as gains in quality-adjusted life-years (QALYs) and years without progression to >25% off-time.


RESULTS
From a societal perspective, entacapone therapy resulted in an incremental cost of US dollars 9327 per QALY gained compared with standard treatment. Treatment with entacapone also provided an additional 7.6 months with < or =25% off-time/day compared with standard treatment. Sensitivity analyses indicated that the model is sensitive to changes in rates of improvement/deterioration of off-time, and to the number of doses per day of levodopa with adjunctive entacapone.


CONCLUSIONS
The addition of entacapone to standard treatment for patients receiving levodopa who experience off-time provides additional QALYs and gain in time with minimal fluctuations. Results of this modelling exercise suggest that therapy with entacapone may be cost effective when compared with standard treatment for PD.
Palmer
Cynthia S
CS
MEDTAP International, Bethesda, Maryland, USA.
Nuijten
Mark J C
MJ
Schmier
Jordana K
JK
Subedi
Prasun
P
Snyder
Edward H
EH
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage* / Q000191:economics; D002396:Catechols / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage* / Q000191:economics; D008390:Markov Chains; D009570:Nitriles; D010300:Parkinson Disease / Q000188:drug therapy* / Q000191:economics*; D017060:Patient Satisfaction; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014481:United States
D000978:Antiparkinson Agents; D002396:Catechols; D009570:Nitriles; D007980:Levodopa; C071192:entacapone