Cost-Effectiveness of Dopamine Agonists and Monoamine Oxidase B Inhibitors in Early Parkinson's Disease

McIntosh, Emma; Kent, Seamus; Gray, Alastair; Clarke, Carl E.; Williams, Adrian; Jenkinson, Crispin; Ives, Natalie; Patel, Smitaa; Rick, Caroline; Wheatley, Keith; Gray, Richard; PD MED Collaborative Group

Abstract

Background: 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). Objectives: The objective was to estimate the cost-effectiveness of levodopa-sparing therapy (dopamine agonists or monoamine oxidase type B inhibitors compared with levodopa alone. Methods: 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. Results: 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. Conclusions: 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.

• Journal Article Type: Article
• Acceptance Date: Apr 5, 2021
• Online Publication Date: May 7, 2021
• Publication Date: Sep 1, 2021
• Deposit Date: Aug 10, 2021
• Publicly Available Date: Aug 10, 2021
• Journal: Movement Disorders
• Print ISSN: 0885-3185
• Electronic ISSN: 1531-8257
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 36
• Issue: 9
• Pages: 2136-2143
• DOI: https://doi.org/10.1002/mds.28623
• Keywords: Clinical Neurology; Neurology
• Public URL: https://nottingham-repository.worktribe.com/output/6010929
• Publisher URL: https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.28623
• Additional Information: Authors on behalf of the PD MED Collaborative Group.