TY - JOUR

T1 - A cost-effectiveness analysis of levodopa/carbidopa intestinal gel compared to standard care in late stage Parkinson's disease in the UK

AU - Lowin, Julia

AU - Bergman, Annika

AU - Chaudhuri, K Ray

AU - Findley, Leslie J

AU - Roeder, Claudia

AU - Schifflers, Mathias

AU - Wood, Eifiona

AU - Morris, Stephen

PY - 2011/7/6

Y1 - 2011/7/6

N2 - OBJECTIVE: Evaluation of cost-effectiveness of levodopa/carbidopa intestinal gel (LCIG), compared to standard care (SC) in patients with advanced Parkinson's disease (aPD) in the UK.DESIGN: Markov model to quantify costs and outcomes associated with LCIG versus SC in aPD patients at Hoehn and Yahr (H&Y) stages 3, 4 or 5 experiencing >50% OFF time per day. Time horizon was lifetime, LCIG treatment was assumed to last maximal 5 years after which patients revert to SC. Model comprised 12 aPD health states according to H&Y status and daily time spent in OFF state. Cost analyses are reported from a UK NHS and Personal Social Services perspective. Uncertainties were assessed through one-way sensitivity analyses.COMPARATORS: LCIG, providing patients with continuous dopaminergic stimulation to maximise functional ON time during the day and SC, defined as medically determined best available oral medication.MAIN OUTCOME MEASURES: Cost-effectiveness, based on quality adjusted life years gained, presented as an incremental cost-effectiveness ratio.RESULTS: Lifetime analysis yields an incremental cost per QALY of £36,024 for LCIG compared to SC (incremental cost £39,644, QALY gain 1.1). Results were sensitive to time on treatment, health state on treatment initiation, and estimates of long term benefit (OWSA results from £32,127 to £66,421 per QALY). Findings must be considered in the context of the study limitations which were mainly due to data availability constraints.CONCLUSIONS: LCIG is an effective treatment, reducing OFF time and improving quality of life in advanced PD. It provides value for money in levodopa-responsive aPD patients with severe motor fluctuations when no other treatment options are effective or suitable. Given LCIG is an orphan drug, it is reasonable to suggest that it may be considered cost-effective in the UK setting. However, further research is needed to complete current data gaps and increase robustness of the model.

AB - OBJECTIVE: Evaluation of cost-effectiveness of levodopa/carbidopa intestinal gel (LCIG), compared to standard care (SC) in patients with advanced Parkinson's disease (aPD) in the UK.DESIGN: Markov model to quantify costs and outcomes associated with LCIG versus SC in aPD patients at Hoehn and Yahr (H&Y) stages 3, 4 or 5 experiencing >50% OFF time per day. Time horizon was lifetime, LCIG treatment was assumed to last maximal 5 years after which patients revert to SC. Model comprised 12 aPD health states according to H&Y status and daily time spent in OFF state. Cost analyses are reported from a UK NHS and Personal Social Services perspective. Uncertainties were assessed through one-way sensitivity analyses.COMPARATORS: LCIG, providing patients with continuous dopaminergic stimulation to maximise functional ON time during the day and SC, defined as medically determined best available oral medication.MAIN OUTCOME MEASURES: Cost-effectiveness, based on quality adjusted life years gained, presented as an incremental cost-effectiveness ratio.RESULTS: Lifetime analysis yields an incremental cost per QALY of £36,024 for LCIG compared to SC (incremental cost £39,644, QALY gain 1.1). Results were sensitive to time on treatment, health state on treatment initiation, and estimates of long term benefit (OWSA results from £32,127 to £66,421 per QALY). Findings must be considered in the context of the study limitations which were mainly due to data availability constraints.CONCLUSIONS: LCIG is an effective treatment, reducing OFF time and improving quality of life in advanced PD. It provides value for money in levodopa-responsive aPD patients with severe motor fluctuations when no other treatment options are effective or suitable. Given LCIG is an orphan drug, it is reasonable to suggest that it may be considered cost-effective in the UK setting. However, further research is needed to complete current data gaps and increase robustness of the model.

KW - Antiparkinson Agents/administration & dosage

KW - Carbidopa/administration & dosage

KW - Cost-Benefit Analysis

KW - Gels/economics

KW - Humans

KW - Levodopa/administration & dosage

KW - Parkinson Disease/drug therapy

KW - Quality-Adjusted Life Years

KW - United Kingdom

U2 - 10.3111/13696998.2011.598201

DO - 10.3111/13696998.2011.598201

M3 - Article

C2 - 21728911

VL - 14

SP - 584

EP - 593

JO - Journal of Medical Economics

JF - Journal of Medical Economics

SN - 1369-6998

IS - 5

ER -