Abstract
Advanced-stage Parkinson’s disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication to IDL were assessed at baseline, and subsequently at 3, 6, 9 and 12 months follow-up. We used the Unified PD Rating Scale (UPDRS) for function and 15D for Quality of Life (QoL). Costs were assessed using quarterly structured patient questionnaires and hospital registries. Costs per quality adjusted life year (QALY) were estimated for conventional treatment prior to switch and for 1-year treatment with IDL. Probabilistic sensitivity analysis was based on bootstrapping. IDL significantly improved functional scores and was safe to use. One-year conventional oral treatment entailed 0.63 QALY while IDL entailed 0.68 (p > 0.05). The estimated total 1-year treatment cost was NOK419,160 on conventional treatment and NOK890,920 on IDL, representing a cost of NOK9.2 million (€1.18 mill) per additional QALY. The incremental cost per unit UPDRS improvement was NOK25,000 (€3,250). Medication was the dominant cost during IDL (45 % of total costs), it represented only 6.4 % of the total for conventional treatment. IDL improves function but is not cost effective using recommended thresholds for cost/QALY in Norway.
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Acknowledgments
Halldis Nedrebø and Hilde Slorafoss are gratefully acknowledged for help and support of the patients and data collection. Harri Sintonen is acknowledged for permission to use the 15D instrument and valuation algorithms. The study was performed with the help of an unspecified study grant from Solvay pharma which is gratefully acknowledged. Katarina Engman, Umbilicus Nordica AB, Umeå, Sweden is acknowledged for excellent monitoring of the study.
Conflicts of interest
Dr Lundqvist reports a study grant from Solvay Pharma during the conduct of the study and grants and personal fees from Abbvie (present manufacturer of the treatment studied) outside the study. Dr Sønbø Kristiansen reports collaboration with the manufacturer of Duodopa® about 10 years ago, and later with Abbvie on other products. Dr Reiertsen reports lecture fees from Abbvie outside the present work. There are no other conflicts of interests reported by the authors.
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Lundqvist, C., Beiske, A.G., Reiertsen, O. et al. Real life cost and quality of life associated with continuous intraduodenal levodopa infusion compared with oral treatment in Parkinson patients. J Neurol 261, 2438–2445 (2014). https://doi.org/10.1007/s00415-014-7515-4
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DOI: https://doi.org/10.1007/s00415-014-7515-4