Advanced

Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson's disease in the UK and Germany

Walter, Evelyn and Odin, Per LU (2015) In Journal of Medical Economics 18(2). p.155-165
Abstract
Background: Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting similar to 5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC). Methods: A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3-5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were... (More)
Background: Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting similar to 5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC). Methods: A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3-5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider's perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon. Results: UK lifetime costs associated with CSAI amounts to 78,251.49 pound and generates 2.85 QALYs and 6.28 LYs ((sic)104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are 130,011.34 pound, achieves 3.06 QALYs and 6.93 LYs ((sic)175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was 244,684.69 pound ((sic)272,914.58). Costs for DBS are 87,730.22 pound, associated with 2.75 QALYs and 6.38 LYs ((sic)105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are 76,793.49; pound 2.62 QALYs and 5.76 LYs were reached ((sic)90,011.91, 2.73 QALYs and 6 LYs for Germany). Conclusions: From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Medical Economics
volume
18
issue
2
pages
155 - 165
publisher
Informa Healthcare
external identifiers
  • wos:000350544900008
  • scopus:84923211483
ISSN
1941-837X
DOI
10.3111/13696998.2014.979937
language
English
LU publication?
yes
id
ca679680-623f-4d39-bdc0-47253ec1205f (old id 5303958)
date added to LUP
2015-05-04 08:39:14
date last changed
2017-10-29 03:49:47
@article{ca679680-623f-4d39-bdc0-47253ec1205f,
  abstract     = {Background: Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting similar to 5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC). Methods: A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3-5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider's perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon. Results: UK lifetime costs associated with CSAI amounts to 78,251.49 pound and generates 2.85 QALYs and 6.28 LYs ((sic)104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are 130,011.34 pound, achieves 3.06 QALYs and 6.93 LYs ((sic)175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was 244,684.69 pound ((sic)272,914.58). Costs for DBS are 87,730.22 pound, associated with 2.75 QALYs and 6.38 LYs ((sic)105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are 76,793.49; pound 2.62 QALYs and 5.76 LYs were reached ((sic)90,011.91, 2.73 QALYs and 6 LYs for Germany). Conclusions: From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.},
  author       = {Walter, Evelyn and Odin, Per},
  issn         = {1941-837X},
  language     = {eng},
  number       = {2},
  pages        = {155--165},
  publisher    = {Informa Healthcare},
  series       = {Journal of Medical Economics},
  title        = {Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson's disease in the UK and Germany},
  url          = {http://dx.doi.org/10.3111/13696998.2014.979937},
  volume       = {18},
  year         = {2015},
}