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Treatment of Advanced Parkinson’s Disease in the United States

A Cost-Utility Model

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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.

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Acknowledgements

The funding source for this manuscript was Teva Neuroscience, Kansas City, MO, USA. Dr Groenendaal is a partner at Vose Consulting US LLC, an independent risk analysis and modeling consulting firm that received research funding for this study from Teva Neuroscience. Dr Tarrants is an employee of Teva Neuroscience, a pharmaceutical company. Dr Armand is an employee of H. Lundbeck A/S and a paid consultant to Teva Neuroscience.

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Authors and Affiliations

  1. Vose Consulting, Boulder, Colorado, USA

    Huybert Groenendaal

  2. Teva Neuroscience, Inc., 901 E. 104th Street, Suite 900, Kansas City, Missouri, 64131, USA

    Marcy L. Tarrants

  3. H. Lundbeck A/S, Paris, France

    Christophe Armand

Authors
  1. Huybert Groenendaal
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  2. Marcy L. Tarrants
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  3. Christophe Armand
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Correspondence to Marcy L. Tarrants.

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Groenendaal, H., Tarrants, M.L. & Armand, C. Treatment of Advanced Parkinson’s Disease in the United States. Clin. Drug Investig. 30, 789–798 (2010). https://doi.org/10.2165/11538520-000000000-00000

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