Document Detail

Treatment of advanced Parkinson's disease in the United States: a cost-utility model.
MedLine Citation:
PMID:  20818839     Owner:  NLM     Status:  MEDLINE    
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.
Huybert Groenendaal; Marcy L Tarrants; Christophe Armand
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical drug investigation     Volume:  30     ISSN:  1173-2563     ISO Abbreviation:  Clin Drug Investig     Publication Date:  2010  
Date Detail:
Created Date:  2010-09-07     Completed Date:  2010-12-15     Revised Date:  2013-11-25    
Medline Journal Info:
Nlm Unique ID:  9504817     Medline TA:  Clin Drug Investig     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  789-98     Citation Subset:  IM    
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MeSH Terms
Antiparkinson Agents / administration & dosage,  economics*,  therapeutic use*
Carbidopa / economics,  therapeutic use
Catechols / economics,  therapeutic use
Cost Savings
Cost-Benefit Analysis
Disease Progression
Drug Administration Schedule
Drug Costs*
Drug Therapy, Combination
Indans / economics,  therapeutic use
Levodopa / economics,  therapeutic use
Markov Chains
Models, Economic*
Nitriles / economics,  therapeutic use
Parkinson Disease / drug therapy*,  economics*,  physiopathology
Quality of Life
Quality-Adjusted Life Years
Stochastic Processes
Time Factors
Treatment Outcome
United States
Reg. No./Substance:
0/Antiparkinson Agents; 0/Catechols; 0/Indans; 0/Nitriles; 003N66TS6T/rasagiline; 46627O600J/Levodopa; 4975G9NM6T/entacapone; MNX7R8C5VO/Carbidopa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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