Hudry Joumana, Rinne Juha O, Keränen Tapani, Eckert Laurent, Cochran John M
International Department of Health Economics and Epidemiology, H Lundbeck A/S, Paris, France.
Ann Pharmacother. 2006 Apr;40(4):651-7. doi: 10.1345/aph.1G454. Epub 2006 Mar 28.
The economic burden of Parkinson's disease (PD) is high, especially in patients experiencing motor fluctuations. Rasagiline has demonstrated efficacy against symptoms of PD in early and advanced stages of the disease.
To assess the cost-utility of rasagiline and entacapone as adjunctive therapies to levodopa versus standard levodopa care in PD patients with motor fluctuations in Finland.
A 2 year probabilistic Markov model with 3 health states: "25% or less off-time/day," "greater than 25% off-time/day," and "dead" was used. Off-time represents time awake with poor or absent motor function. Model inputs included transition probabilities from randomized clinical trials, utilities from a preference measurement study, and costs and resources from a Finnish cost-of-illness study. Effectiveness measures were quality-adjusted life years (QALYs) and number of months spent with 25% or less off-time/day. Uncertainty around parameters was taken into account by Monte Carlo simulations.
Over 2 years from a societal perspective, rasagiline or entacapone as adjunctive therapies to levodopa showed greater effectiveness than levodopa alone at no additional costs. Benefits after 2 years were 0.13 (95% CI 0.08 to 0.17) additional QALYs and 5.2 (3.6 to 6.7) additional months for rasagiline and 0.12 (0.08 to 0.17) QALYs and 5.1 (3.5 to 6.6) months for entacapone, both in adjunct to levodopa compared with levodopa alone.
The results of this study support the use of rasagiline and entacapone as adjunctive cost-effective alternatives to levodopa alone in PD patients with motor fluctuations in Finland. With a different mode of action, rasagiline is a valuable therapeutic alternative to entacapone at no additional charge to society.
帕金森病（PD）的经济负担高昂，尤其是在出现运动波动的患者中。雷沙吉兰已证明在疾病的早期和晚期阶段对PD症状均有效。
评估在芬兰患有运动波动的PD患者中，雷沙吉兰和恩他卡朋作为左旋多巴辅助治疗与标准左旋多巴治疗相比的成本效益。
采用一个为期2年的概率马尔可夫模型，包含3种健康状态：“每日关期时间为25%或更少”、“每日关期时间大于25%”和“死亡”。关期表示运动功能不佳或丧失时的清醒时间。模型输入包括来自随机临床试验的转移概率、偏好测量研究中的效用值，以及芬兰疾病成本研究中的成本和资源。有效性指标为质量调整生命年（QALY）以及每日关期时间为25%或更少的月数。通过蒙特卡洛模拟考虑参数的不确定性。
从社会角度来看，在2年期间，雷沙吉兰或恩他卡朋作为左旋多巴的辅助治疗，在不增加成本的情况下比单独使用左旋多巴显示出更高的有效性。2年后，与单独使用左旋多巴相比，雷沙吉兰辅助治疗的益处为额外0.13（95%CI 0.08至0.17）个QALY和额外5.2（3.6至6.7）个月，恩他卡朋辅助治疗的益处为额外0.12（0.08至0.17）个QALY和额外5.1（3.5至6.6）个月。
本研究结果支持在芬兰患有运动波动的PD患者中，将雷沙吉兰和恩他卡朋作为单独使用左旋多巴的具有成本效益的替代辅助治疗方法。由于作用方式不同，雷沙吉兰是恩他卡朋的一种有价值的治疗替代方案，且对社会无需额外费用。
