ND4 - COST-EFFECTIVENESS EVALUATION OF THE INTRA-DUODENAL CONTINUOUS LEVODOPA INFUSION IN ADVANCED AND SEVERE PARKINSON’S DISEASE

Abstract

Motor fluctuations are a common problem in the long-term management of Parkinson’s disease (PD), resulting in disability and impaired quality of life (QoL). The purpose of this analysis was to estimate the cost-effectiveness of Levodopa Continuous Infusion of Gel (LCIG) compared with Optimized Conventional Oral Therapy (OCOT). The prospective, double-blind, placebo-controlled, multicenter trial, long-term study (CECILE) was conducted in routine care with 1-year follow-up at 21 sites in France between December 2010 and March 2016. Patient and family caregivers’ questionnaires were used to collate all outpatient care. The use of resources in hospitals was evaluated using a PMSI survey of the participated centers. Health-related QoL was measured utilizing PDQ-39 and EQ-5D-3L that were administered during every visit. Outcome measure for this analysis were the incremental cost-effectiveness ratio (ICER), defined as the incremental cost divided by the number of QALYs saved and the Net Monetary Benefit (NMB). The uncertainty was apprehended by the bootstrap method approach. The 6-month costs associated with LCIG amounts to €13 189 and generates 0.207 QALYs. The difference of QALYs between two treatment arms was significant. The ICER was negative, LCIG has a lower cost and greater utility compared to OCOT. LCIG dominates OCOT. The NMB of LCIG is always greater than the conventional oral treatment. The dominance of LCIG is clearly demonstrated in the cost-effectiveness acceptability curves: two curves do not intersect which means that treatment of levodopa is the optimal treatment regardless of the willingness-to-pay (WTP) level. Continuous enteral levodopa infusion achieves a reduction of motor fluctuations and dyskinesias improving patients’ QoL, despite the progression of PD motor symptoms and a significant decline in cognitive functions. From a health-economic perspective, LCIG is a cost-effective therapy and could be seen as an alternative treatment to OCOT for the patients with advanced PD.