A cost-effectiveness analysis of levodopa/carbidopa intestinal gel compared to standard care in late stage Parkinson’s disease in the UK

Abstract

Objective:

Evaluation of cost-effectiveness of levodopa/carbidopa intestinal gel (LCIG), compared to standard care (SC) in patients with advanced Parkinson’s disease (aPD) in the UK.

Design:

Markov model to quantify costs and outcomes associated with LCIG versus SC in aPD patients at Hoehn and Yahr (H&Y) stages 3, 4 or 5 experiencing >50% OFF time per day. Time horizon was lifetime, LCIG treatment was assumed to last maximal 5 years after which patients revert to SC. Model comprised 12 aPD health states according to H&Y status and daily time spent in OFF state. Cost analyses are reported from a UK NHS and Personal Social Services perspective. Uncertainties were assessed through one-way sensitivity analyses.

Comparators:

LCIG, providing patients with continuous dopaminergic stimulation to maximise functional ON time during the day and SC, defined as medically determined best available oral medication.

Main outcome measures:

Cost-effectiveness, based on quality adjusted life years gained, presented as an incremental cost-effectiveness ratio.

Results:

Lifetime analysis yields an incremental cost per QALY of £36,024 for LCIG compared to SC (incremental cost £39,644, QALY gain 1.1). Results were sensitive to time on treatment, health state on treatment initiation, and estimates of long term benefit (OWSA results from £32,127 to £66,421 per QALY). Findings must be considered in the context of the study limitations which were mainly due to data availability constraints.

Conclusions:

LCIG is an effective treatment, reducing OFF time and improving quality of life in advanced PD. It provides value for money in levodopa-responsive aPD patients with severe motor fluctuations when no other treatment options are effective or suitable. Given LCIG is an orphan drug, it is reasonable to suggest that it may be considered cost-effective in the UK setting. However, further research is needed to complete current data gaps and increase robustness of the model.

Keywords::

• Advanced Parkinson’s disease
• Cost-effectiveness
• Incremental cost-effectiveness ratio (ICER)
• Levodopa/carbidopa intestinal gel
• Off time
• Quality adjusted life years (QALY)

Transparency

Declaration of funding

This study was funded by Abbott Healthcare Products Ltd, manufacturer of LCIG, marketed as Duodopa. The funding body gave access to currently unpublished data and provided assistance in study design, data analysis and result interpretation.

Declaration of financial/other relationships

J.L., C.R., and E.W. are employees of IMS Health who received consultancy fees from Abbott. A.B. and M.S. were/are employees of Abbott and contributed to manuscript and review before submission. K.R.C., L.J.F., and S.M. supported the study with their clinical and health economic expertise, contributed to manuscript and review, and received honoraria for this work.

Acknowledgements

No assistance in the preparation of this article is to be declared.

Notes

*Duodopa is a registered trade name of Abbott, UK.