, Volume 19, Issue 8, pp 875–886 | Cite as

Cost-Effectiveness Analysis of Dopamine Agonists in the Treatment of Parkinson’s Disease in Japan

  • Takuro Shimbo
  • Kenji Hira
  • Manabu Takemura
  • Tsuguya Fukui
Original Research Article


Background: Dopamine agonists such as bromocriptine or pergolide are often used in Japan to treat Parkinson’s disease. Dopamine agonists are relatively expensive drugs; economic evaluations are required.

Objective: To evaluate the cost effectiveness of dopamine agonists for the treatment of Parkinson’s disease in Japan.

Design and setting: We used a Markov model to simulate the course of Parkinson’s disease and to compare the cost effectiveness of dopamine agonists added to levodopa with that of levodopa alone in Japan. The model assumed that 60-year-old men with Parkinson’s disease in Hoehn-Yahr (HY) stages 2 to 5 using levodopa were administered dopamine agonists or continued on levodopa alone. The incremental cost effectiveness of dopamine agonists used for 10 years was then estimated.

Study perspective: Societal.

Main outcome measures and results: In the patients in HY stage 2, the incremental cost effectiveness of dopamine agonists was 18 610 000 to 19 320 000 yen (¥) per quality-adjusted life-year (QALY) [$US172 300 to $US178 900/QALY; 1998 values]. In patients in HY stage 3 or higher, the use of dopamine agonists was dominant over levodopa alone mainly due to reduced cost for care. In sensitivity analyses, costs and effectiveness of dopamine agonists significantly influenced the results. The use of a generic formulation of bromocriptine was dominant over levodopa alone even in the patients with HY stage 2 disease.

Conclusions: Dopamine agonists appear to be cost effective in advanced Parkinson’s disease, although their use is sensitive to the costs and effectiveness of dopamine agonists. If factors discouraging the prescription of generic drugs in Japan were removed, the treatment of Parkinson’s disease would become more cost effective.


  1. 1.
    Kusumi M, Nakashima K, Harada H, et al. Epidemiology of Parkinson’s disease in Yonago City, Japan: comparison with a study carried out 12 years ago. Neuroepidemiology 1996; 15: 201–7PubMedCrossRefGoogle Scholar
  2. 2.
    Whetten-Goldstein K, Sloan F, Kulas E, et al. The burden of Parkinson’s disease on society, family, and the individual. J Am Geriatr Soc 1997; 45: 844–9PubMedGoogle Scholar
  3. 3.
    LePen C, Wait S, Moutard-Martin F, et al. Cost of illness and disease severity in a cohort of French patients with Parkinson’s disease. Pharmacoeconomics 1999; 16: 59–69PubMedCrossRefGoogle Scholar
  4. 4.
    Siderowf AD, Holloway RG, Stern MB. Cost-effectiveness analysis in Parkinson’s disease: determining the value of interventions. Mov Disord 2000; 15: 439–45PubMedCrossRefGoogle Scholar
  5. 5.
    Hoerger TJ, Bala MV, Rowland C, et al. Cost effectiveness of pramipexole in Parkinson’s disease in the US. Pharmacoeconomics 1998; 14: 541–57PubMedCrossRefGoogle Scholar
  6. 6.
    Olanow CW, Koller WC. An algorithm (decision tree) for the management of Parkinson’s disease: treatment guidelines. Neurology 1998; 50 (3 Suppl. 3): S1–S57PubMedCrossRefGoogle Scholar
  7. 7.
    Aminoff MJ. Parkinson’s disease and other extrapyramidal disorders. In: Fauci AS, Braunwald E, Isselbacher KJ, et al., editors. Harrison’s principles of internal medicine. 14th ed. New York: McGraw-Hill, 1998: 2356–63Google Scholar
  8. 8.
    Beck JR, Pauker SG. The Markov process in medical prognosis. Med Decis Making 1983; 3: 419–57PubMedCrossRefGoogle Scholar
  9. 9.
    Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Making 1993; 13: 322–38PubMedCrossRefGoogle Scholar
  10. 10.
    Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology 1967; 17: 427–42PubMedCrossRefGoogle Scholar
  11. 11.
    Dodel RC, Eggert KM, Singer MS, et al. Costs of drug treatment in Parkinson’s disease. Mov Disord 1998; 13: 249–54PubMedCrossRefGoogle Scholar
  12. 12.
    Lees AJ. Comparison of therapeutic effects and mortality data of levodopa and levodopa combined with selegiline in patients with early, mild Parkinson’s disease. Parkinson’s Disease Research Group of the United Kingdom. BMJ 1995; 311: 1602–7PubMedCrossRefGoogle Scholar
  13. 13.
    Poewe WH, Wenning GK. The natural history of Parkinson’s disease. Neurology 1996; 47 (6 Suppl. 3): S146–52PubMedCrossRefGoogle Scholar
  14. 14.
    Uitti RJ, Ahlskog JE, Maraganore DM, et al. Levodopa therapy and survival in idiopathic Parkinson’s disease: Olmsted County project. Neurology 1993; 43: 1918–26PubMedCrossRefGoogle Scholar
  15. 15.
    The Ministry of Health and Welfare (Japan). Life table. Vital Statistics. Tokyo, 1997Google Scholar
  16. 16.
    Mizuno Y, Kondo T, Narabayashi H. Pergolide in the treatment of Parkinson’s disease. Neurology 1995; 45 (3 Suppl. 3): S13–21PubMedCrossRefGoogle Scholar
  17. 17.
    Maier-Hoehn MM. Parkinsonism treated with levodopa: progression and mortality. J Neural Transm Suppl. 1983; 19: 253–64PubMedGoogle Scholar
  18. 18.
    Marttila RJ, Rinne UK. Progression and survival in Parkinson’s disease. Acta Neurol Scand 1991; 84 Suppl. 136: 24–48CrossRefGoogle Scholar
  19. 19.
    Microsoft Excel Version 5.0. Redmond (WA): Microsoft Corporation, 1994Google Scholar
  20. 20.
    Lieberman AN, Neophytides A, Leibowitz M, et al. Comparative efficacy of pergolide and bromocriptine in patients with advanced Parkinson’s disease. Adv Neurol 1983; 37: 95–108PubMedGoogle Scholar
  21. 21.
    LeWitt PA, Ward CD, Larsen TA, et al. Comparison of pergolide and bromocriptine therapy in parkinsonism. Neurology 1983; 33: 1009–14PubMedCrossRefGoogle Scholar
  22. 22.
    Pezzoli G, Martignoni E, Pacchetti C, et al. Pergolide compared with bromocriptine in Parkinson’s disease: a multicenter, crossover, controlled study. Mov Disord 1994; 9: 431–6PubMedCrossRefGoogle Scholar
  23. 23.
    Toyokura Y, Iwata M, Kase M, et al. Clinical utility of bromocriptine in Parkinsonian syndrome: multi-centric investigation in comparison with amantadine hydrochloride by double blind method [in Japanese]. Rinsyo-Hyouka 1984; 12: 369–401Google Scholar
  24. 24.
    Toyokura Y, Mizuno Y, Kase M, et al. Therapeutic effect of bromocriptine in Parkinsonian syndrome: combined therapy with levodopa in comparison between bromocriptine and placebo by double blind method [in Japanese]. Rinsyo-Hyouka 1984; 12: 403–43Google Scholar
  25. 25.
    Nakanishi T, Mizuno Y, Goto I, et al. A nationwide collaborative study on the long-term effects of BR in patients with Parkinson’s disease: the fourth interim report. Eur Neurol 1991; 31 Suppl. 1: 3–16PubMedCrossRefGoogle Scholar
  26. 26.
    Narabayashi H, Ando K, Kowa H, et al. Clinical utility of pergolide mesilate (LY127809) on Parkinson’s disease: double blind study in comparison with bromocriptine mesilate [in Japanese]. Igaku-to-Yakugaku 1992; 27: 147–211Google Scholar
  27. 27.
    Olanow CW, Fahn S, Muenter M, et al. A multicenter double-blind placebo-controlled trial of pergolide as an adjunct to Sinemet in Parkinson’s disease. Mov Disord 1994; 9: 40–7PubMedCrossRefGoogle Scholar
  28. 28.
    Narabayashi H, Ando K, Kowa H, et al. Phase II study of pergolide mesylate (LY 127809) in Parkinson’s disease. Multi-center open study [in Japanese]. Rinsyo-Iyaku 1991; 7: 151–92Google Scholar
  29. 29.
    Drummond ME, O’Brien B, Stoddart HL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997Google Scholar
  30. 30.
    Gold MR, Siegel JE, Russel LB, et al. Cost-effectiveness in health and medicine. Oxford: Oxford University Press, 1996Google Scholar
  31. 31.
    Institute of Health Insurance (Japan). The standard table of reimbursement for drugs. Tokyo: The Institute, 1998Google Scholar
  32. 32.
    Statistics and Information Department, Minister’s Secretariat, Ministry of Health and Welfare. Patient survey 1996, Vol. 1. Tokyo: Association of Health Statistics, 1996Google Scholar
  33. 33.
    Statistics and Information Department, Minister’s Secretariat, Ministry of Health and Welfare. Reports of investigation for individual medical conducts in the society. Tokyo: Association of Health Statistics, 1998Google Scholar
  34. 34.
    Ministry of Labour (Japan). Report of monthly labor statistics. The Ministry, Apr 1999Google Scholar
  35. 35.
    DATA 3.5, Williamstown (MA): Treeage software, Inc., 1999Google Scholar
  36. 36.
    Chrischilles EA, Rubenstein LM, Voelker MD, et al. The health burdens of Parkinson’s disease. Mov Disord 1998; 13: 406–13PubMedCrossRefGoogle Scholar
  37. 37.
    Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 1992; 146: 473–81PubMedGoogle Scholar
  38. 38.
    Babazono A, Hillman AL. Declining cost-effectiveness of screening for disease: the case of gastric cancer in Japan. Int J Technol Assess Health Care 1995; 11: 354–64PubMedCrossRefGoogle Scholar
  39. 39.
    Okubo I, Glick H, Frumkin H, et al. Cost-effectiveness analysis of mass screening for breast cancer in Japan. Cancer 1991; 67: 2021–9PubMedCrossRefGoogle Scholar
  40. 40.
    Shimbo T, Glick HA, Eisenberg JM. Cost-effectiveness analysis of strategies for colorectal cancer screening in Japan. Int J Technol Assess Health Care 1994; 10: 359–75PubMedCrossRefGoogle Scholar
  41. 41.
    Matsunaga G, Tsuji I, Sato S, et al. Cost-effective analysis of mass screening for cervical cancer in Japan. J Epidemiol 1997; 7: 135–41PubMedCrossRefGoogle Scholar
  42. 42.
    Detsky AS. A clinician’s guide to cost-effectiveness analysis. Ann Intern Med 1990; 113: 147–54PubMedGoogle Scholar
  43. 43.
    Hadorn DC. Setting health care priorities in Oregon. Cost-effectiveness meets the rule of rescue. JAMA 1991; 265: 2218–25PubMedCrossRefGoogle Scholar
  44. 44.
    Department of Pharmaceutical Affairs, The Ministry of Health and Welfare (Japan). Report of the conference on desirable pharmaceutics in the 21st century; 1993 May 28; Tokyo. Tokyo: Yakuji-Nippou Co., 1993: 31–3Google Scholar
  45. 45.
    Bower AD, Burkett GL. Family physicians and generic drugs: a study of recognition, information sources, prescribing attitudes, and practices. J Fam Pract 1987; 24: 612–6PubMedGoogle Scholar
  46. 46.
    Banahan III BF, Kolassa EM. A physician survey on generic drugs and substitution of critical dose medications. Arch Intern Med 1997; 157: 2080–8PubMedCrossRefGoogle Scholar
  47. 47.
    Nohria V, Partiot A. A review of the efficacy of the dopamine agonists pergolide and bromocriptine in the treatment of Parkinson’s disease. Eur J Neurol 1997; 4: 537–43CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  • Takuro Shimbo
    • 1
  • Kenji Hira
    • 1
  • Manabu Takemura
    • 2
  • Tsuguya Fukui
    • 1
  1. 1.Department of General Medicine and Clinical Epidemiology, Graduate School of MedicineKyoto University HospitalKyotoJapan
  2. 2.Department of NeurologyYasaka-cho National Medical Insurance HospitalKyotoJapan

Personalised recommendations