The cost-effectiveness of levodopa/carbidopa intestinal gel compared to standard care in advanced Parkinson’s disease

Abstract

Background: 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.

Aims: To determine the cost-effectiveness of LCIG vs standard of care (SoC) for the treatment of aPD patients.

Methods: 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 Hoehn & Yahr (H&Y) 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.

Results: 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.

Conclusion: LCIG is a cost-effective treatment option compared with SoC in patients with aPD.

Keywords:

• Parkinson’s disease
• advanced Parkinson’s disease
• cost-effectiveness
• levodopa/carbidopa intestinal gel

Transparency

Declaration of funding

This study and manuscript were funded by AbbVie. The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the study design, research, interpretation of data, writing, review, and approval of the manuscript.

Declaration of financial/other relationships

JL and HK were/are salaried employees of QuintilesIMS, who received consultancy fees from AbbVie. KS, TM, YJJ, and RB are employees of AbbVie, and may own AbbVie stock or stock options; they contributed to study design, data interpretation, manuscript development, and review. KRC has received educational funding from UCB and honoraria for sponsored symposiums from UCB, AbbVie, Britannia, US Worldmeds, Otsuka, Medtronic, and Zambon. He has also acted as a consultant for AbbVie, UCB, Britannia, Medtronic, and Mundipharama. KRC supported the study with his clinical expertise and contributed to the manuscript and review. The authors have no other relevant affiliations or financial involvement with any organization or entity with financial interest in, or financial conflict with, the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

We would like to acknowledge Professor Michael Hutchinson, Department of Neurology, Saint Vincent’s Hospital Dublin, Ireland, for his input on the clinical practice in Ireland.