PHARMACOECONOMIC ANALYSIS OF USING SINEMET CR OVER STANDARD SINEMET IN PARKINSONIAN-PATIENTS WITH MOTOR FLUCTUATIONS

OBJECTIVE: TO compare the costs of pharmacotherapy in patients with Pa rkinson's disease before and after converting from standard Sinemet to extended-release Sinemet CR. DESIGN: Investigators retrospectively re viewed records of patients converting from Sinemet to Sinemet CR for e fficacy and total drug costs. Cost-effectiveness was evaluated retrosp ectively fi om data collected in prospective Sinemet CR efficacy trial s. SETTING: Parkinson's disease clinic at a tertiary care university t eaching hospital. PATIENTS: 100 patients with motor fluctuations who h ad undergone an initial 6-month course of Sinemet therapy, followed by a 6-month course of Sinemet CR. MAIN OUTCOME MEASURES: Total cost was measured as the cost of Sinemet formulations plus the costs of other antiparkinson medications. Differences in pre-and postconversion costs were compared by using the paired, two-tailed Student's t-test. A sub study of 39 patients on the cost-effectiveness of conversion measured the ratio of daily medication costs to the daily hours ''on'' without chorea RESULTS: While total daily medication costs after conversion in creased by 21%, patients experienced either a comparable or an improve d degree of disease control with Sinemet CR. Patients who were also ta king selegiline were able to decrease selegiline expense by 20%. The c osts of other adjunctive medications did not differ significantly afte r conversion. The cost-effectiveness analysis revealed an increase in postconversion on time by 2.2 hours (p = 0.0001), accompanied by a $2. 85 decrease in total cost per hour on without chorea (p = 0.11). CONCL USIONS: Although Sinemet CR is more costly, it may be more cost-effect ive in patients with motor fluctuations. Some patients may be able to reduce adjunctive medications.