Abstract
The PD MED study reported small but persistent benefits in patient-rated mobility scores and quality of life from initiating therapy with levodopa compared with levodopa-sparing therapies in early Parkinson's disease (PD). The objective was to estimate the cost-effectiveness of levodopa-sparing therapy (dopamine agonists or monoamine oxidase type B inhibitors compared with levodopa alone. PD MED is a pragmatic, open-label randomized, controlled trial in which patients newly diagnosed with PD were randomly assigned between levodopa-sparing therapy (dopamine agonists or monoamine oxidase type B inhibitors ) and levodopa alone. Mean quality-adjusted life-years and costs were calculated for each participant. Differences in mean quality-adjusted life-years and costs between levodopa and levodopa-sparing therapies and between dopamine agonists and monoamine oxidase type B inhibitors were estimated using linear regression. Over a mean observation period of 4 years, levodopa was associated with significantly higher quality-adjusted life-years (difference, 0.18; 95% CI, 0.05-0.30; P < 0.01) and lower mean costs (£3390; £2671-£4109; P < 0.01) than levodopa-sparing therapies, the difference in costs driven by the higher costs of levodopa-sparing therapies. There were no significant differences in the costs of inpatient, social care, and institutional care between arms. There was no significant difference in quality-adjusted life-years between those allocated dopamine agonists and monoamine oxidase type B inhibitors (0.02; -0.17 to 0.13 in favor of dopamine agonists; P=0.81); however costs were significantly lower for those allocated monoamine oxidase type B inhibitors (£2321; £1628-£3015; P < 0.01) because of the higher costs of dopamine agonists. There were no significant differences between arms for other costs. Initial treatment with levodopa is highly cost-effective compared with levodopa-sparing therapies. Monoamine oxidase type B inhibitors, as initial levodopa-sparing therapy was more cost-effective, with similar quality-adjusted life-years but lower costs than dopamine agonists. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Highlights
We have extended these analyses by reporting a cost-utility analysis of levodopa versus levodopa-sparing therapies, and of dopamine agonists (DAs) versus monoamine oxidase type B inhibitors (MAOBIs) carried out alongside the Parkinson’s disease (PD) MED trial
Baseline EQ-5D utility was higher for those assigned MAOBI than for those assigned DA (0.68 vs 0.65; P for difference = 0.03)
The percentages of missing data in each year were similar across different types of resource use and Health-Related Quality of Life (HRQoL) and increased with follow-up time (Table S2)
Summary
Motor complications are seen less frequently with levodopa-sparing therapies, nonmotor side effects such as nausea, hallucinations, edema, and sleep disturbance are more frequent with DAs than with levodopa.[7,8]. The PD MED trial demonstrated that the overall balance of benefits and risks favors levodopa over levodopa-sparing therapies with better patient-rated Health-Related Quality of Life (HRQoL) in both the short and long term. There were no significant differences in the rate of dementia, institutionalization, or mortality.[1] In cases for which levodopa-sparing therapy is deemed appropriate, DAs have traditionally been preferred to MAOBIs, which are perceived as less effective. In PD MED, patient-rated HRQoL was marginally better for those allocated MAOBIs.[1] We have extended these analyses by reporting a cost-utility analysis of levodopa versus levodopa-sparing therapies, and of DAs versus MAOBIs carried out alongside the PD MED trial
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