COST-EFFECTIVENESS OF PRAMIPEXOLE IN PARKINSONS-DISEASE IN THE US

Objective: Pramipexole was recently approved in the US for treatment o f the symptoms of idiopathic Parkinson's disease (PD). Although pramip exole has been found to be safe and efficacious when compared with pla cebo, little data are yet available on its cost effectiveness when com pared with baseline treatment. The aim of this study was to estimate t he costs and cost effectiveness (cost utility) of pramipexole compared with baseline treatment in patients with early and advanced PD. Desig n and Setting: We developed a cost-effectiveness (CE) model in the US setting that linked Unified Parkinson's Disease Rating Scale (UPDRS) P arts II (activities of daily life) and III (motor) scores to disease p rogression, costs and patient utility. Data for the model were obtaine d from clinical trials, a literature review and a survey of 193 patien ts' health resource use and utility. We used cost and quality-adjusted life-year (QALY) estimates from the model to estimate the incremental cost effectiveness of pramipexole relative to baseline treatment patt erns. We performed separate analyses for patients with early and advan ced PD. We also performed extensive sensitivity analyses by adding oth er dopamine agonists to the no-pramipexole treatment regimen and varyi ng disease progression parameters. The study was conducted from the so cietal perspective, although data presentation allows interpretation o f cost effectiveness from either the societal or payer perspective. Ma in Outcome Measures and Results: For patients with both early and adva nced PD, treatment with pramipexole had higher costs but was more effe ctive than baseline treatment. For patients with early onset of PD, th e incremental total CE ratio for pramipexole was $US8837/QALY. For pat ients with advanced PD, the incremental CE ratio was $US12294/QALY (19 97 costs). These ratios were lower than the CE ratios of many widely u sed medical treatments. Conclusions: Subject to the inherent limitatio ns of modelling chronic disease progression and subsequent healthcare costs and patient utility, the results suggested that pramipexole was a cost effective treatment for patients with early and advanced PD in the US.