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Cost Effectiveness of Treatment of Parkinson’s Disease with Entacapone in the United States

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Abstract

Objective: To determine the cost effectiveness of adjunctive therapy with entacapone versus standard treatment (levodopa) without entacapone for patients in the US with Parkinson’s disease (PD)who experience ‘off-time’ (re-emergence of the symptoms of PD) while receiving levodopa.

Study Design: A Markov model was used to estimate 5-year costs and effectiveness of standard treatment with and without entacapone.

Methods: Probabilities, unit costs, resource utilisation data and utilities were obtained from published literature, clinical trial reports, a national database, and clinical experts. PD disability was measured using the daily proportion of off-time and Hoehn and Yahr scale scores. The analysis measured costs from a societal and third-party payer perspective, and effectiveness as gains in quality-adjusted life-years (QALYs) and years without progression to >25% off-time.

Results: From a societal perspective, entacapone therapy resulted in an incremental cost of $US9327 per QALY gained compared with standard treatment. Treatment with entacapone also provided an additional 7.6 months with ≤25% off-time/day compared with standard treatment. Sensitivity analyses indicated that the model is sensitive to changes in rates of improvement/deterioration of off-time, and to the number of doses per day of levodopa with adjunctive entacapone.

Conclusions: The addition of entacapone to standard treatment for patients receiving levodopa who experience off-time provides additional QALYs and gain in time with minimal fluctuations. Results of this modelling exercise suggest that therapy with entacapone may be cost effective when compared with standard treatment for PD.

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Notes

  1. The ‘pull test’ is a standard component of assessment of postural stability in Parkinson’s disease. It evaluates the response to sudden, strong posterior displacement produced by pulling on the shoulders while the patient is erect with eyes open and feet slightly apart. The patient is prepared.

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Acknowledgements

This study was funded by Novartis Pharmaceuticals Corporation but was executed by MEDTAP, an independent reseach organisation. There was no conflict of interest for the authors.

We are grateful to Ariel Gordin, MD, PhD, Kari Reinikainen, MD, PhD, Mika Leinonen MSc, and Eeva Taimela, MD, PhD of Orion Pharma for providing clinical trial data and collaboration to MEDTAP. Additionally, we would like to thank the following individuals for their contribution to this study as members of the clinical panel: Jean Hubble, MD, Ohio State University Parkinson’s Disease Center of Excellence, Columbus, Ohio; Kapil Sethi, MD, Department of Neurology of the Medical College of Georgia, Augusta, Georgia; Kelly Lyons, PhD, Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas; Ruth Hagenstuen, RN, MA, Struthers Parkinson Center, Minneapolis, Minnesota; and Jonie Whitehouse, RN, BSN, Wisconsin Institute for Neurologic and Sleep Disorders, Milwaukee, Wisconsin. We are also grateful to the Parkinson Study Group (PSG) who participated in the study and to Melissa Kuehn and Barbara Godlew for their work in preparing the manuscript.

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Authors and Affiliations

  1. MEDTAP International, Bethesda, Maryland, USA

    Cynthia S. Palmer & Prasun Subedi

  2. MEDTAP International, Molenpad 4; NL-1546 LC, Jisp (N-H), Amsterdam, The Netherlands

    Mark J.C. Nuijten

  3. Exponent, Inc., Alexandria, Virginia, USA

    Jordana K. Schmier

  4. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA

    Edward H. Snyder

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  1. Cynthia S. Palmer
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Correspondence to Mark J.C. Nuijten.

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Palmer, C.S., Nuijten, M.J., Schmier, J.K. et al. Cost Effectiveness of Treatment of Parkinson’s Disease with Entacapone in the United States. Pharmacoeconomics 20, 617–628 (2002). https://doi.org/10.2165/00019053-200220090-00005

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