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The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England

BACKGROUND: Parkinson’s disease is a progressive neurodegenerative disease, which significantly impacts patients’ quality of life and is associated with high treatment and direct healthcare costs. In England, levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of levodopa-respons...

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Autores principales: Chaudhuri, K. Ray, Pickard, A. Simon, Alobaidi, Ali, Jalundhwala, Yash J., Kandukuri, Prasanna L., Bao, Yanjun, Sus, Julia, Jones, Glynn, Ridley, Christian, Oddsdottir, Julia, Najle-Rahim, Seyavash, Madin-Warburton, Matthew, Xu, Weiwei, Schrag, Anette
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9095547/
https://www.ncbi.nlm.nih.gov/pubmed/35307793
http://dx.doi.org/10.1007/s40273-022-01132-y
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author Chaudhuri, K. Ray
Pickard, A. Simon
Alobaidi, Ali
Jalundhwala, Yash J.
Kandukuri, Prasanna L.
Bao, Yanjun
Sus, Julia
Jones, Glynn
Ridley, Christian
Oddsdottir, Julia
Najle-Rahim, Seyavash
Madin-Warburton, Matthew
Xu, Weiwei
Schrag, Anette
author_facet Chaudhuri, K. Ray
Pickard, A. Simon
Alobaidi, Ali
Jalundhwala, Yash J.
Kandukuri, Prasanna L.
Bao, Yanjun
Sus, Julia
Jones, Glynn
Ridley, Christian
Oddsdottir, Julia
Najle-Rahim, Seyavash
Madin-Warburton, Matthew
Xu, Weiwei
Schrag, Anette
author_sort Chaudhuri, K. Ray
collection PubMed
description BACKGROUND: Parkinson’s disease is a progressive neurodegenerative disease, which significantly impacts patients’ quality of life and is associated with high treatment and direct healthcare costs. In England, levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of levodopa-responsive advanced Parkinson’s disease with troublesome motor fluctuations when available combinations of medicinal products are unsatisfactory. OBJECTIVE: We aimed to determine the cost effectiveness of LCIG compared to the standard of care for patients with advanced Parkinson’s disease in England, using real-world data. METHODS: A Markov model was adapted from previous published studies, using the perspective of the English National Health System and Personal and Social Services to evaluate the cost effectiveness of LCIG compared to standard of care in patients with advanced Parkinson’s disease over a 20-year time horizon. The model comprised 25 health states, defined by a combination of the Hoehn and Yahr scale, and waking time spent in OFF-time. The base case considered an initial cohort of patients with an Hoehn and Yahr score of ≥ 3, and > 4 h OFF-time. Standard of care comprised standard oral therapies, and a proportion of patients were assumed to be treated with subcutaneous apomorphine infusion or injection in addition to oral therapies. Efficacy inputs were based on LCIG clinical trials where possible. Resource use and utility values were based on results of a large-scale observational study, and costs were derived from the latest published UK data, valued at 2017 prices. The EuroQol five-dimensions-3-level (EQ-5D-3L) instrument was used to measure utilities. Costs and quality-adjusted life-years were discounted at 3.5%. Both deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Total costs and quality-adjusted life-years gained for LCIG vs standard of care were £586,832 vs £554,022, and 2.82 vs 1.43, respectively. The incremental cost-effectiveness ratio for LCIG compared to standard of care was £23,649/quality-adjusted life-year. Results were sensitive to the healthcare resource utilisation based on real-world data, and long-term efficacy of LCIG. CONCLUSIONS: The base-case incremental cost-effectiveness ratio was estimated to be within the acceptable thresholds for cost effectiveness considered for England. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40273-022-01132-y.
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spelling pubmed-90955472022-05-13 The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England Chaudhuri, K. Ray Pickard, A. Simon Alobaidi, Ali Jalundhwala, Yash J. Kandukuri, Prasanna L. Bao, Yanjun Sus, Julia Jones, Glynn Ridley, Christian Oddsdottir, Julia Najle-Rahim, Seyavash Madin-Warburton, Matthew Xu, Weiwei Schrag, Anette Pharmacoeconomics Original Research Article BACKGROUND: Parkinson’s disease is a progressive neurodegenerative disease, which significantly impacts patients’ quality of life and is associated with high treatment and direct healthcare costs. In England, levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of levodopa-responsive advanced Parkinson’s disease with troublesome motor fluctuations when available combinations of medicinal products are unsatisfactory. OBJECTIVE: We aimed to determine the cost effectiveness of LCIG compared to the standard of care for patients with advanced Parkinson’s disease in England, using real-world data. METHODS: A Markov model was adapted from previous published studies, using the perspective of the English National Health System and Personal and Social Services to evaluate the cost effectiveness of LCIG compared to standard of care in patients with advanced Parkinson’s disease over a 20-year time horizon. The model comprised 25 health states, defined by a combination of the Hoehn and Yahr scale, and waking time spent in OFF-time. The base case considered an initial cohort of patients with an Hoehn and Yahr score of ≥ 3, and > 4 h OFF-time. Standard of care comprised standard oral therapies, and a proportion of patients were assumed to be treated with subcutaneous apomorphine infusion or injection in addition to oral therapies. Efficacy inputs were based on LCIG clinical trials where possible. Resource use and utility values were based on results of a large-scale observational study, and costs were derived from the latest published UK data, valued at 2017 prices. The EuroQol five-dimensions-3-level (EQ-5D-3L) instrument was used to measure utilities. Costs and quality-adjusted life-years were discounted at 3.5%. Both deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Total costs and quality-adjusted life-years gained for LCIG vs standard of care were £586,832 vs £554,022, and 2.82 vs 1.43, respectively. The incremental cost-effectiveness ratio for LCIG compared to standard of care was £23,649/quality-adjusted life-year. Results were sensitive to the healthcare resource utilisation based on real-world data, and long-term efficacy of LCIG. CONCLUSIONS: The base-case incremental cost-effectiveness ratio was estimated to be within the acceptable thresholds for cost effectiveness considered for England. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40273-022-01132-y. Springer International Publishing 2022-03-21 2022 /pmc/articles/PMC9095547/ /pubmed/35307793 http://dx.doi.org/10.1007/s40273-022-01132-y Text en © Crown 2022 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research Article
Chaudhuri, K. Ray
Pickard, A. Simon
Alobaidi, Ali
Jalundhwala, Yash J.
Kandukuri, Prasanna L.
Bao, Yanjun
Sus, Julia
Jones, Glynn
Ridley, Christian
Oddsdottir, Julia
Najle-Rahim, Seyavash
Madin-Warburton, Matthew
Xu, Weiwei
Schrag, Anette
The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England
title The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England
title_full The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England
title_fullStr The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England
title_full_unstemmed The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England
title_short The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England
title_sort cost effectiveness of levodopa-carbidopa intestinal gel in the treatment of advanced parkinson’s disease in england
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9095547/
https://www.ncbi.nlm.nih.gov/pubmed/35307793
http://dx.doi.org/10.1007/s40273-022-01132-y
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