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

Abstract

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.

The potential price and access implications of the cost-utility and budget impact methodologies applied by NICE in England and ICER in the US for a novel gene therapy in Parkinson’s disease

“…The choice of structure is informed by a number of cost-utility studies performed in PD [33–37], as well as Abbvie’s submission for Duodopa to the Scottish Medicines Consortium in Scotland (which was accepted for reimbursement for PD patients with severe motor fluctuations and hyper-/dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results) [38]. …”

“…The timing and choice of therapy is driven by the patient’s individual circumstances, meaning it is not possible to precisely define the standard of care (SOC) as a single therapy. This fact is reflected in several published health economic analyses, where the treatment in the comparator arm is commonly a homogeneous group of treatments referred to as SOC or best medical therapy [33–37,43–46]. Therefore, given the lack of a single clearly defined SOC per disease stage, we apply the available groupings of therapeutic options for a given SOC and the associated clinical and economic outcomes.…”

“…The health state-specific costs applied in the model are UK specific and derived from McCrone (2009) [47] and Lowin et al (2011) [33], and inflated to £2015 using the Health Service Cost Indices [48]. When adapting the model to the US analysis, these costs were inflated using the Organisation for Economic Co-operation and Development’s (OECD) most recent (2014) purchasing power parity conversion factor for health costs [49].…”

“…The transition probabilities for the standard disease trajectory dictate the proportion of patients deteriorating during each cycle, and were obtained from the cost-effectiveness studies published by Eggington et al (2014) [35] and Lowin et al (2011) [33]. Mortality in the model is driven by the age of the patient, adjusted for the mortality effect of the H&Y score, informed by the hazard ratios reported by Liou et al (2009) [52].…”

The resolution of Expert Board meeting «Advanced stage of Parkinson’s disease. Possibilities of the transition to non-invasive methods of treatment». Moscow. Dec16 2016

“…Улучшение моторных функций на фоне лечения ЛКИГ делает пациента более независимым, снимает бре-мя ухода с родственников, положительно влияя на их ка-чество жизни, а также приводит к снижению затрат на со-циальную помощь. Несмотря на высокую стоимость ме-тода, есть убедительные научные данные, доказывающие, что использование технологии инфузии ЛКИГ уменьшает социально-экономическое бремя развернутых стадий БП и является экономически целесообразным, с учетом каче-ства жизни пациента и ожидаемой продолжительности жизни [11,12]. Уровень коэффициента «затраты -эф-фективность» при таком виде лечения считается приемле-мым, особенно с учетом потенциально небольшого коли-чества нуждающихся пациентов.…”