Drugs & Aging

, Volume 26, Issue 9, pp 791–801 | Cite as

Cost Effectiveness of Rasagiline and Pramipexole as Treatment Strategies in Early Parkinson’s Disease in the UK Setting

An Economic Markov Model Evaluation
  • Alan Haycox
  • Christophe Armand
  • Susana Murteira
  • John Cochran
  • Clément François
Original Research Article

Abstract

Background

Levodopa is the most effective treatment for the symptoms of Parkinson’s disease (PD). However, after an initial period of benefit, several limitations become apparent, including motor complications such as dyskinesia. Dyskinesia can severely affect patients’ quality of life and increases healthcare resource use. Thus, delaying the need for levodopa, and therefore the onset of levodopa-induced dyskinesia, is important.

Objective

The aim of this study was to compare the cost effectiveness, from a UK healthcare payer perspective, of two antiparkinsonian treatment strategies in early PD: first-line monotherapy with rasagiline, a novel monoamine oxidase B inhibitor; and the non-ergoline dopamine receptor agonist pramipexole.

Methods

An economic Markov model was developed as a pragmatic tool to derive comparative information on the effectiveness, utility and costs of these two strategies over a 5-year period. Model input data were obtained from the TEMPO study for rasagiline and from a study by the Parkinson Study Group for pramipexole. Effectiveness outcomes were time to levodopa and time to levodopa-induced dyskinesia. Cost and quality-adjusted life-year (QALY) data were derived from published sources.

Results

Rasagiline was the dominant strategy. Compared with pramipexole, use of the rasagiline strategy was estimated to reduce costs by 18% per patient over 5 years and was associated with an additional 10% delay in dyskinesia onset (0.41 years; 95% CI 0.27, 0.55). This strategy was also found to prolong the time to levodopa initiation by 25% through a gain of 0.83 levodopa-free years (95% CI 0.56, 1.1). In addition, use of the rasagiline strategy was found to generate a 5% gain in QALYs over 5 years compared with the pramipexole strategy (3.7±0.02 vs 3.51±0.03). Sensitivity analyses confirmed that the model was robust.

Conclusions

Rasagiline represents a cost-effective alternative to pramipexole in the treatment of early PD in the UK.

Notes

Acknowledgements

Funding from H. Lundbeck A/S supported this work.

Professor Alan Haycox has no conflicts of interest that are directly relevant to the content of this study. Christophe Armand, Susana Murteira, John Cochran and Clément François are employees of H. Lundbeck A/S, the marketing authorization holder for rasagiline in several European countries.

The authors wish to express their sincere thanks to and acknowledge Dr Donald Grosset, of the Department of Neurology, Southern General Hospital, Glasgow, for his extensive neurological and scientific advice on the content of this article. The authors would also like to thank Natalie Barker from Wolters Kluwer Health for her assistance with editing of the manuscript.

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Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Alan Haycox
    • 1
  • Christophe Armand
    • 2
  • Susana Murteira
    • 2
  • John Cochran
    • 2
  • Clément François
    • 2
  1. 1.University of Liverpool Management SchoolLiverpoolUK
  2. 2.H. Lundbeck A/SParisFrance

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