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Modelling the Cost Effectiveness of Treatments for Parkinson’s Disease

A Methodological Review

  • Review Article
  • Cost-Effectiveness Models for Parkinson’s Disease
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Abstract

The objective of this review was to assess models of cost effectiveness for Parkinson’s disease (PD) published after July 2002 and to derive recommendations for future modelling.

A systematic literature search was performed in the databases PubMed, Current Contents, EMBASE, EconLit, the Cochrane Database of Systematic Reviews, and DARE (Database of Abstracts of Reviews of Effectiveness), NHS EED (Economic Evaluation Database) and HTA (Health Technology Assessment) of the UK NHS Centre for Review and Dissemination (July 2002 to March 2010). Only fully published studies using decision trees, Markov models, individual simulation models or sets of mathematical equations were included.

Most of the 11 studies identified used Markov models (n = 9) and two employed were based on decision trees. Based on the Hoehn & Yahr (HY) scale, authors evaluated the cost effectiveness of drug treatments (n = 6), surgical approaches such as deep brain stimulation (n = 1) or striatal cell grafting (n = 1), and diagnostic procedures such as single photon emission computed tomography (SPECT) testing (n = 3) over a time horizon of 1 year to lifetime. Costs were adapted to address a societal and/or healthcare provider/ third-party payer perspective. All but one of the interventions investigated were considered cost effective or cost saving.

Cost-effectiveness modelling in PD between 2003 and 2010 showed only minor improvement when compared with our earlier review of models published from 1998 up to 2003. Cost-effectiveness modelling recommendations were complied with to only a limited extent, leaving room for quality improvement. More advanced modelling approaches may, so far, be underrepresented, but may be used in the future, driven by the research question. Adverse events of treatment, co-morbidities or disease complications are not yet sufficiently included in the models to adequately represent clinical reality.

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Notes

  1. Cabergoline, along with other ergoline dopamine agonists, was removed for the treatment of PD from the market in 2007 due to cardiac adverse effects.[66]

  2. The disease is considered to be in an ‘on’ stage when the symptoms respond well to treatment. The disease is considered to be in an ‘off’ stage when it is either not or not adequately responding to treatment and the patient is experiencing significant symptoms.

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Acknowledgements

The authors have no conflicts of interest that are directly relevant to the content of this study. Full financial disclosure for Professor Dr R. Dodel is available as SDC 2, http://links.adisonline.com/PCZ/A122.

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Authors and Affiliations

  1. Department of Neurology, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany

    Judith Dams, Jens Peter Reese, Wolfgang H. Oertel &  Richard Dodel

  2. Department of Public Health and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria

    Bernhard Bornschein, Annette Conrads-Frank & Uwe Siebert

  3. Department of Health Policy and Management, Harvard School of Public Health, Center for Health Decision Science, Boston, MA, USA

    Uwe Siebert

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  1. Judith Dams
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  2. Bernhard Bornschein
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  5. Wolfgang H. Oertel
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Correspondence to Richard Dodel.

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Dams, J., Bornschein, B., Reese, J.P. et al. Modelling the Cost Effectiveness of Treatments for Parkinson’s Disease. Pharmacoeconomics 29, 1025–1049 (2011). https://doi.org/10.2165/11587110-000000000-00000

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