Treatment of advanced Parkinson's disease in the United States: a cost-utility model.
BACKGROUND
As Parkinson's disease (PD) progresses, patients and their families experience substantial health and economic burdens. Because motor fluctuations (also called 'off-time') are linked to poor quality of life and higher healthcare costs, minimizing off-time is an effective strategy for reducing costs associated with PD.


OBJECTIVE
To assess the cost utility of rasagiline or entacapone as adjunctive therapies to levodopa versus levodopa/carbidopa/entacapone (LCE) versus standard levodopa monotherapy in patients with advanced PD and motor fluctuations in the US.


METHODS
A 2-year stochastic Markov model was utilized to examine the cost effectiveness of treatments of advanced PD. The model assumed that patients transition health status every 4 months. Transition probabilities, including uncertainties, were estimated from clinical trial data. Medical costs, daily drug costs and utility weights were obtained from published literature.


RESULTS
Over 2 years, all therapy options showed greater effectiveness than levodopa alone. Rasagiline+levodopa and LCE were cost saving from a payor perspective, while entacapone+levodopa was cost saving from a societal perspective. Mean benefits over 2 years were 0.12 (90% credibility interval [CI] 0.07, 0.18) additional quality-adjusted life-years (QALYs) for rasagiline+levodopa, entacapone+levodopa and LCE, 5.08 (90% CI 3.87, 6.28) additional months with <or=25% off-time for rasagiline+levodopa and 4.85 (90% CI 3.63, 6.06) additional months with <or=25% off-time for entacapone+levodopa and LCE versus levodopa alone.


CONCLUSIONS
From a payor perspective, rasagiline+levodopa and LCE were dominant therapies over levodopa monotherapy, while entacapone+levodopa was effective at a higher cost. With no additional cost over a 2-year period, rasagiline+levodopa presents a valuable alternative to entacapone+levodopa, LCE and levodopa monotherapy in the treatment of advanced PD patients. Results from this cost-utility model and prior adjunctive clinical data provide ongoing support for the adjunctive use of rasagiline in advanced PD patients with motor fluctuations.
Groenendaal
Huybert
H
Vose Consulting, Boulder, Colorado, USA.
Tarrants
Marcy L
ML
Armand
Christophe
C
D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D002230:Carbidopa / Q000191:economics / Q000627:therapeutic use; D002396:Catechols / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004334:Drug Administration Schedule; D016527:Drug Costs; D004359:Drug Therapy, Combination; D006801:Humans; D007189:Indans / Q000191:economics / Q000627:therapeutic use; D007980:Levodopa / Q000191:economics / Q000627:therapeutic use; D008390:Markov Chains; D018803:Models, Economic; D009570:Nitriles / Q000191:economics / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013269:Stochastic Processes; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
D000978:Antiparkinson Agents; D002396:Catechols; D007189:Indans; D009570:Nitriles; C031967:rasagiline; D007980:Levodopa; C071192:entacapone; D002230:Carbidopa
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