title: Cabergoline versus levodopa monotherapy: a decision analysis.
abstract: We evaluated the incremental cost-effectiveness of cabergoline compared with levodopa monotherapy in patients with early Parkinson's disease (PD) in the German healthcare system. The study design was based on cost-effectiveness analysis using a Markov model with a 10-year time horizon. Model input data was based on a clinical trial "Early Treatment of PD with Cabergoline" as well as on cost data of a German hospital/office-based PD network. Direct and indirect medical and nonmedical costs were included. Outcomes were costs, disease stage, cumulative complication incidence, and mortality. An annual discount rate of 5% was applied and the societal perspective was chosen. The target population included patients in Hoehn and Yahr Stages I to III. It was found that the occurrence of motor complications was significantly lower in patients on cabergoline monotherapy. For patients aged >/=60 years of age, cabergoline monotherapy was cost effective when considering costs per decreased UPDRS score. Each point decrease in the UPDRS (I-IV) resulted in costs of euro;1,031. Incremental costs per additional motor complication-free patient were euro;104,400 for patients <60 years of age and euro;57,900 for patients >/=60 years of age. In conclusion, this decision-analytic model calculation for PD was based almost entirely on clinical and observed data with a limited number of assumptions. Although costs were higher in patients on cabergoline, the corresponding cost-effectiveness ratio for cabergoline was at least as favourable as the ratios for many commonly accepted therapies.
authors.affiliation: Medical Economics Research Group (MERG), Munich, Germany.
authors.forename: Antje M
authors.initials: AM
authors.lastname: Smala
authors.forename: E Annika
authors.initials: EA
authors.lastname: Spottke
authors.forename: Olaf
authors.initials: O
authors.lastname: Machat
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Dieter
authors.initials: D
authors.lastname: Meyer
authors.forename: Rudolf
authors.initials: R
authors.lastname: Köhne-Volland
authors.forename: Martin
authors.initials: M
authors.lastname: Reuther
authors.forename: Janeen
authors.initials: J
authors.lastname: DuChane
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.forename: Karin B
authors.initials: KB
authors.lastname: Berger
authors.forename: Richard C
authors.initials: RC
authors.lastname: Dodel
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000077465:Cabergoline; D003362:Cost-Benefit Analysis; D003657:Decision Making; D018450:Disease Progression; D004873:Ergolines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D012720:Severity of Illness Index
chemical_list: D000978:Antiparkinson Agents; D004873:Ergolines; D007980:Levodopa; D000077465:Cabergoline