Cost analysis of the treatments for patients with advanced Parkinson's disease: SCOPE study

Abstract

Objective:

To perform a comparative long-term analysis of the associated healthcare costs for the therapeutic options in advanced Parkinson’s Disease (PD): deep brain stimulation (DBS), continuous duodenal levodopa-carbidopa infusion (CDLCI), and continuous subcutaneous apomorphine infusion (CSAI).

Methods:

Resource use associated with the pre-treatment period, procedure, and follow-up was assessed for the three therapies from the perspective of the Spanish national healthcare system. Resources consumption was measured with a Healthcare Resources Questionnaire (at nine advanced PD centres). Unit costs (Euro-Spain 2010) were applied to measure resource use to obtain the average total cost for each therapy over 5 years.

Results:

Mean cumulative 5-year cost per patient was significantly lower with DBS (€88,014) vs CSAI (€141,393) and CDLCI (€233,986) (p < 0.0001). DBS was associated with the lowest cumulative costs from year 2, with a yearly average cost of €17,603 vs €46,797 for CDLCI (p = 0.001) and €28,279 for CSAI (p = 0.008). For every patient treated annually with CDLCI, two could be treated with DBS (or €29,194 could be saved) and for every patient treated with CSAI, €10,676 could be saved with DBS. The initial DBS investment (32.2% of the total 5-year costs) was offset by decreases in anti-Parkinsonian drugs and follow-up costs. CDLCI and CSAI required constant drug use (i.e., levodopa and carbidopa for CDLCI, apomorphine for CSAI), representing ∼95% of their total 5-year cost.

Limitations:

All costs were based on a questionnaire, not on actual clinical data. The study is not a cost-effectiveness analysis as there is a lack of comparable outcomes data. An expert panel was used due to the complexity and variability in the treatment of advanced PD. The sample size was relatively small.

Conclusions:

Overall, DBS requires less use of health resources than CDLCI or CSAI in advanced PD patients, mostly pharmacological. The initial DBS investment was offset at year 2 by reductions in the ongoing consumption of anti-Parkinsonian medication. For every patient treated annually with CDLCI or CSAI, substantial cost savings could be made with DBS.

Keywords::

• Apomorphine infusion pump
• Deep brain stimulation
• Duodenal levodopa infusion
• Economic analysis
• Parkinson’s disease

Transparency

Declaration of funding

This research was funded by Medtronic International Sarl, Tolochenaz, Switzerland.

Declaration of financial/other relationships

FV received honoraria from Medtronic for this study and has received honoraria for lectures or advice from: Bohringer Ingelheim España, Abbot Laboratories (Manufacture and Commercialization of Duodopa [CDLCI]), Italfarmaco (Commercialization of Apomorphine [CSAI] in Spain), Medtronic Ibérica, UCB Pharmaceuticals and Novartis. JP-J received honoraria for consultancy from Medtronic for this study. RP-P received honoraria for consultancy from Medtronic for this study and participated in the study while working at the Centre for in Health and Economics (CRES), Universitat Pompeu Fabra, prior to joining the Office of Health Economics (OHE), London. OHE receives an annual conditional research grant from the Association of the British Pharmaceutical Industry (ABPI). The ABPI Code of Practice for the pharmaceutical industry regulates marketing of prescription medicines by companies based in the UK. Duodopa is produced and commercialized by Abbott, a member company of the ABPI. Abbott did not have any input in this study. The views expressed in this paper are those of the authors and are not necessarily those of either OHE or ABPI or Abbott. Neither OHE nor ABPI are in a position to endorse the findings of this report, which was funded by Medtronic Ibérica, S.A. Paloma González and Cristina Canal work for Medtronic Ibérica SA.

Acknowledgements

This paper was edited by an English-speaking professional medical writer, Deborah Nock (DPP-Cordell, Saxthorpe, UK), funded by Medtronic International Sarl, Tolochenaz, Switzerland.