title: A cost-effectiveness analysis of levodopa/carbidopa intestinal gel compared to standard care in late stage Parkinson's disease in the UK.
abstract: OBJECTIVE
  Evaluation of cost-effectiveness of levodopa/carbidopa intestinal gel (LCIG), compared to standard care (SC) in patients with advanced Parkinson's disease (aPD) in the UK.
  
  
  METHODS
  Markov model to quantify costs and outcomes associated with LCIG versus SC in aPD patients at Hoehn and Yahr (H&Y) stages 3, 4 or 5 experiencing >50% OFF time per day. Time horizon was lifetime, LCIG treatment was assumed to last maximal 5 years after which patients revert to SC. Model comprised 12 aPD health states according to H&Y status and daily time spent in OFF state. Cost analyses are reported from a UK NHS and Personal Social Services perspective. Uncertainties were assessed through one-way sensitivity analyses.
  
  
  METHODS
  LCIG, providing patients with continuous dopaminergic stimulation to maximise functional ON time during the day and SC, defined as medically determined best available oral medication.
  
  
  METHODS
  Cost-effectiveness, based on quality adjusted life years gained, presented as an incremental cost-effectiveness ratio.
  
  
  RESULTS
  Lifetime analysis yields an incremental cost per QALY of £36,024 for LCIG compared to SC (incremental cost £39,644, QALY gain 1.1). Results were sensitive to time on treatment, health state on treatment initiation, and estimates of long term benefit (OWSA results from £32,127 to £66,421 per QALY). Findings must be considered in the context of the study limitations which were mainly due to data availability constraints.
  
  
  CONCLUSIONS
  LCIG is an effective treatment, reducing OFF time and improving quality of life in advanced PD. It provides value for money in levodopa-responsive aPD patients with severe motor fluctuations when no other treatment options are effective or suitable. Given LCIG is an orphan drug, it is reasonable to suggest that it may be considered cost-effective in the UK setting. However, further research is needed to complete current data gaps and increase robustness of the model.
authors: IMS Health, London NW1 6JB, UK.
authors: Julia
authors: J
authors: Lowin
authors: Annika
authors: A
authors: Bergman
authors: K Ray
authors: KR
authors: Chaudhuri
authors: Leslie J
authors: LJ
authors: Findley
authors: Claudia
authors: C
authors: Roeder
authors: Mathias
authors: M
authors: Schifflers
authors: Eifiona
authors: E
authors: Wood
authors: Stephen
authors: S
authors: Morris
mesh_terms: D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002230:Carbidopa / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005782:Gels / Q000191:economics*; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology*; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
chemical_list: D000978:Antiparkinson Agents; D005782:Gels; D007980:Levodopa; D002230:Carbidopa