The cost-effectiveness of levodopa/carbidopa intestinal gel compared to standard care in advanced Parkinson’s disease
| Autor: | Thomas S. Marshall, Rakhi Baj, Julia Lowin, Henrietta Konwea, Kavita Sail, Yash J. Jalundhwala, K R Chaudhuri |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Parkinson's disease Cost effectiveness Cost-Benefit Analysis macromolecular substances Disease Antiparkinson Agents Levodopa 03 medical and health sciences 0302 clinical medicine Standard care Humans Medicine 030212 general & internal medicine Severely disabling business.industry Health Policy Carbidopa Parkinson Disease medicine.disease Markov Chains Drug Combinations Levodopa carbidopa Physical therapy Health Resources Female Quality-Adjusted Life Years Health Expenditures business Gels Ireland human activities 030217 neurology & neurosurgery |
| Zdroj: | Journal of Medical Economics. 20:1207-1215 |
| ISSN: | 1941-837X 1369-6998 |
| Popis: | Parkinson's disease (PD) is an incurable, progressive neurological condition, with symptoms impacting movement, walking, and posture that eventually become severely disabling. Advanced PD (aPD) has a significant impact on quality-of-life (QoL) for patients and their caregivers/families. Levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of advanced levodopa-responsive PD with severe motor fluctuations and hyper-/dyskinesia when available combinations of therapy have not given satisfactory results.To determine the cost-effectiveness of LCIG vs standard of care (SoC) for the treatment of aPD patients.A Markov model was used to evaluate LCIG vs SoC in a hypothetical cohort of 100 aPD patients with severe motor fluctuations from an Irish healthcare perspective. Model health states were defined by HoehnYahr (HY) scale-combined with amount of time in OFF-time-and death. SoC comprised of standard oral therapy ± subcutaneous apomorphine infusion and standard follow-up visits. Clinical efficacy, utilities, and transition probabilities were derived from published studies. Resource use was estimated from individual patient-level data from Adelphi 2012 UK dataset, using Irish costs, where possible. Time horizon was 20 years. Costs and outcomes were discounted at 4%. Both one-way and probabilistic sensitivity analyses were conducted.The incremental cost-effectiveness ratio for LCIG vs SOC was €26,944/quality adjusted life year (QALY) (total costs and QALYs for LCIG vs SoC: €537,687 vs €514,037 and 4.37 vs 3.49, respectively). LCIG is cost-effective at a payer threshold of €45,000. The model was most sensitive to health state costs.LCIG is a cost-effective treatment option compared with SoC in patients with aPD. |
| Databáze: | OpenAIRE |
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