Authors: Groenendaal, Huybert¹; Tarrants, Marcy L.²; Armand, Christophe³

Source: Clinical Drug Investigation, Volume 30, Number 11, 1 November 2010 , pp. 789-798(10)

Publisher: Adis International

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 ≤25% off-time for rasagiline + levodopa and 4.85 (90% CI 3.63, 6.06) additional months with ≤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.

Keywords: Carbidopa, therapeutic use; Catechol-O-methyltransferase-inhibitors, therapeutic use; Cost-utility; Dopamine-receptor-agonists, therapeutic use; Elderly; Entacapone, therapeutic use; Levodopa, therapeutic use; Monoamine-oxidase-B-inhibitors, therapeutic use; Parkinson's-disease, treatment; Rasagiline, therapeutic use

Document Type: Research article

Affiliations: 1: 1 Vose Consulting, Boulder, Colorado, USA 2: 2 Teva Neuroscience, Kansas City, Missouri, USA 3: 3 H. Lundbeck A/S, Paris, France

Publication date: 2010-11-01

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