title: Treatment of advanced Parkinson's disease in the United States: a cost-utility model.
abstract: 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.
authors.affiliation: Vose Consulting, Boulder, Colorado, USA.
authors.forename: Huybert
authors.initials: H
authors.lastname: Groenendaal
authors.forename: Marcy L
authors.initials: ML
authors.lastname: Tarrants
authors.forename: Christophe
authors.initials: C
authors.lastname: Armand
mesh_terms: 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
chemical_list: D000978:Antiparkinson Agents; D002396:Catechols; D007189:Indans; D009570:Nitriles; C031967:rasagiline; D007980:Levodopa; C071192:entacapone; D002230:Carbidopa
references.citation: Pharmacoeconomics. 1998 Sep;14(3):299-312
references.pmid: 10186468
references.citation: Neurol Clin. 1996 May;14(2):317-35
references.pmid: 8827174
references.citation: Mov Disord. 2005 Nov;20(11):1449-54
references.pmid: 16007641
references.citation: Am J Health Syst Pharm. 2000 May 15;57(10):953-62
references.pmid: 10832495
references.citation: Value Health. 2004 Sep-Oct;7(5):610-26
references.pmid: 15367256
references.citation: Pharmacoeconomics. 1998 Nov;14(5):541-57
references.pmid: 10344917
references.citation: Am J Med. 1982 Dec;73(6):883-8
references.pmid: 7148881
references.citation: CNS Drugs. 2004;18(2):105-11
references.pmid: 14728057
references.citation: Pharmacoeconomics. 1999 Jul;16(1):59-69
references.pmid: 10539122
references.citation: Qual Life Res. 2000;9(7):819-27
references.pmid: 11297024
references.citation: Mov Disord. 2005 Nov;20(11):1397-404
references.pmid: 16092116
references.citation: Neurology. 2004 Mar 23;62(6):937-42
references.pmid: 15037696
references.citation: J Am Geriatr Soc. 1997 Jul;45(7):844-9
references.pmid: 9215336
references.citation: Pharmacoeconomics. 2001;19(10):1013-38
references.pmid: 11735671
references.citation: Lancet. 2005 Mar 12-18;365(9463):947-54
references.pmid: 15766996
references.citation: Parkinsonism Relat Disord. 2003 Jan;9(3):163-8
references.pmid: 12573872
references.citation: Ann Pharmacother. 2006 Apr;40(4):651-7
references.pmid: 16569799