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  • Title: Treatment of advanced Parkinson's disease in the United States: a cost-utility model.
    Author: Groenendaal H, Tarrants ML, Armand C.
    Journal: Clin Drug Investig; 2010; 30(11):789-98. PubMed ID: 20818839.
    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. CONCLUSION: 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.
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