Pramipexole v. levodopa as initial treatment for Parkinson's disease: a randomized clinical-economic trial.
OBJECTIVE
To determine the 2-year incremental cost effectiveness of initial pramipexole treatment compared with initial levodopa treatment in patients with early Parkinson's disease (PD).


METHODS
301 subjects with early PD were randomized to either pramipexole or levodopa and followed every 3 months over a 2-year period. Costs were assigned to patient collected health utilization data using a variety of methods. Health state preferences were estimated using the EuroQol.


RESULTS
Pramipexole strategy was an estimated 2,138 dollars (SE = 1,182 dollars) more expensive than levodopa strategy. The incremental cost-effectiveness of pramipexole compared with levodopa was 106,900 dollars/QALY (EQ-5D), compared with pramipexole being dominated by levodopa using the EQVAS.


CONCLUSIONS
Although considerable uncertainty exists in the 2-year cost-effectiveness of initial pramipexole compared with initial levodopa in the treatment of early PD, our estimates suggest that pramipexole may not be welfare enhancing during the first 2 years of treatment. If initial pramipexole results in long-term improvements in quality of life, its cost-effectiveness will become more favorable.
Noyes
Katia
K
Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, New York, USA.
Dick
Andrew W
AW
Holloway
Robert G
RG
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000191:economics*; D052160:Benzothiazoles; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004361:Drug Tolerance; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007980:Levodopa / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000191:economics*; D010919:Placebos; D000077487:Pramipexole; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013844:Thiazoles / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use
D000978:Antiparkinson Agents; D052160:Benzothiazoles; D010919:Placebos; D013844:Thiazoles; D007980:Levodopa; D000077487:Pramipexole