Cabergoline versus levodopa monotherapy: a decision analysis.
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.
Smala
Antje M
AM
Medical Economics Research Group (MERG), Munich, Germany.
Spottke
E Annika
EA
Machat
Olaf
O
Siebert
Uwe
U
Meyer
Dieter
D
Köhne-Volland
Rudolf
R
Reuther
Martin
M
DuChane
Janeen
J
Oertel
Wolfgang H
WH
Berger
Karin B
KB
Dodel
Richard C
RC
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
D000978:Antiparkinson Agents; D004873:Ergolines; D007980:Levodopa; D000077465:Cabergoline