title: Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson's disease in the UK and Germany.
abstract: BACKGROUND
  Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting ∼ 5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC).
  
  
  METHODS
  A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3-5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider's perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon.
  
  
  RESULTS
  UK lifetime costs associated with CSAI amounts to £78,251.49 and generates 2.85 QALYs and 6.28 LYs (€104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are £130,011.34, achieves 3.06 QALYs and 6.93 LYs (€175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was £244,684.69 (€272,914.58). Costs for DBS are £87,730.22, associated with 2.75 QALYs and 6.38 LYs (€105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are £76,793.49; 2.62 QALYs and 5.76 LYs were reached (€90,011.91, 2.73 QALYs and 6 LYs for Germany).
  
  
  CONCLUSIONS
  From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.
authors.affiliation: IPF Institute for Phamaeconomic Research , Vienna , Austria.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Walter
authors.forename: Per
authors.initials: P
authors.lastname: Odin
mesh_terms: D000978:Antiparkinson Agents / Q000191:economics* / Q000627:therapeutic use*; D001058:Apomorphine / Q000191:economics* / Q000627:therapeutic use*; D002230:Carbidopa / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D046690:Deep Brain Stimulation / Q000191:economics; D004334:Drug Administration Schedule; D005782:Gels; D005858:Germany; D006801:Humans; D007279:Injections, Subcutaneous; D007980:Levodopa / Q000191:economics / Q000627:therapeutic use; D008390:Markov Chains; D017059:Models, Econometric; D010300:Parkinson Disease / Q000188:drug therapy*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D000978:Antiparkinson Agents; D005782:Gels; D007980:Levodopa; D002230:Carbidopa; D001058:Apomorphine
keywords: Advanced Parkinson disease; Apomorphine; Cost-utility-analysis; Germany; UK