Shortterm cost and health consequences of duodena

Authors: Ivar Sønbø Kristiansen Kerstin Bingefors Dag Nyholm Dag Isacson

Publish Date: 2012/08/06

Volume: 7, Issue: 3, Pages: 167-180

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Abstract

Levodopa is the cornerstone treatment for Parkinson’s disease but the short halflife of levodopa limits its usefulness in late stages of the disease Duodenal levodopa infusion DLI allows more stable plasma levels and better motor symptom controlBased on a clinical randomized crossover study with 24 patients DIREQT a decision analytic model predicted 2year drug costs and QALYs for conventional oral therapy and for DLI Healthrelated quality of life HRQOL was recorded using a 15dimensional 15D utility instrument at baseline and during the two 3week trial periods and then at eight followup visits during the subsequent 6 months Use of medication was based on data from DIREQT and previous studies Unit costs were based on market prices drugs and customary charges in Sweden All costs were expressed in Swedish kronor SEK year 2004 values €100 ≈ SEK917 US100 = SEK747 Future costs and outcomes were discounted at 3 Oneway and probabilistic sensitivity analyses were conductedThe mean utility scores were 077 for DLI and 072 for conventional therapy p = 002 A considerable variation in the scores was observed during the study The expected perpatient 2year cost of DLI was SEK562000 while it was SEK172 000 for conventional therapy The mean number of QALYs was 148 and 142 respectively representing an incremental cost of SEK61 million per QALY for DLI all values discounted at 3 Using other assumptions in sensitivity analyses the cost per QALY could be as low as SEK456000This analysis can be considered exploratory only it is based on very limited data Nevertheless our findings suggest that DLI results in a significant improvement in HRQOL However the cost per QALY is likely to be higher than customary costeffectiveness thresholds Whether these benefits justify the additional costs depends on how the health benefits are measured and how these benefits are valued by societyThis study was initiated and funded by Neopharma/Solvay According to the contract between the researchers and the company the former have the right to publish material from the study but the company has the right to comment upon such material before it is published All researchers had access to the full data file and the analyses were undertaken by the researchers D Nyholm was employed by NeoPharma in 1999–2000 has an ongoing consultancy agreement with Solvay Pharma and has received honoraria from Neopharma/ Solvay for lectures and a book chapter I Kristiansen D Isacson and K Bingefors received honoraria for this work

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