Cost Effectiveness of Rasagiline and Pramipexole as Treatment Strategies in Early Parkinson’s Disease in the UK Setting
- 277 Downloads
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.
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.
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.
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.
Rasagiline represents a cost-effective alternative to pramipexole in the treatment of early PD in the UK.
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.
- 10.Maurel F, Lilliu H, Le Pen C. Social and economic cost of L-dopa-induced dyskinesias in patients with Parkinson’s disease. Rev Neurol (Paris) 2001 May; 157(5): 507–14Google Scholar
- 14.National Collaborating Centre for Chronic Conditions. Parkinson’s disease: national clinical guideline for diagnosis and management in primary and secondary care. London: Royal College of Physicians, 2006Google Scholar
- 15.Haute Autorité de Santé. Guide. Affection de longue durée (ALD No. 16). Syndromes parkinsoniens dégénératifs ou secondaires non réversibles [online]. Available from URL: http://www.has-sante.fr [Accessed 2007 Nov 5]
- 16.Horstink M, Tolosa E, Bonuccelli U, et al. Review of the therapeutic management of Parkinson’s disease. Report of a joint task force of the European Federation of Neurological Societies and the Movement Disorder Society — European Section. Part I: early (uncomplicated) Parkinson’s disease. Eur J Neurol 2006 Nov; 13(11): 1170–85PubMedCrossRefGoogle Scholar
- 17.IMS Health. IMS retail drug monitor [online]. Available from URL: http://www.imshealth.com [Accessed 2006 May 1]
- 22.Olanow CW, Rascol O. Early rasagiline treatment slows UPDRS decline in the ADAGIO delayed-start study [abstract no. WIP-11]. 133rd Annual Meeting of the American Neurological Association; 2008 Sep 21–24; Salt Lake City (UT)Google Scholar
- 33.Lew MF, Hauser RA, TEMPO Extension Group. Long-term efficacy of rasagiline in Parkinson’s disease [poster P250]. 9th International Congress of Parkinson’s Disease and Movement Disorders; 2005 Mar 5–8; New Orleans (LA)Google Scholar
- 40.Boehringer Ingelheim GmbH. Mirapexin®: summary of product characteristics [online]. Available from URL: http://www.sifrol.com [Accessed 2007 Jan 1]
- 41.Teva Biosciences. Azilect®. Summary of product characteristics [online]. Available from URL: http://www.azilect.eu [Accessed 2005 Jan 1]
- 42.Organisation for Economic and Co-operation and Development. OECD StatsExtracts [online]. Available from URL: http://stats.oecd.org/wbos/default.aspx?querytype=view&queryname=221 [Accessed 2008 Jan 1]
- 47.National Institute for Health and Clinical Excellence. Guidance for manufacturers and sponsors [online]. Available from URL: http://www.nice.org.uk/niceMedia/pdf/technicalguidanceformanufacturersandsponsors.pdf [Accessed 2001 Jan 1]