Haycox Alan, Armand Christophe, Murteira Susana, Cochran John, François Clément
University of Liverpool Management School, Liverpool, UK.
Drugs Aging. 2009;26(9):791-801. doi: 10.2165/11316770-000000000-00000.
Levodopa is the most effective treatment for the symptoms of Parkinson's disease (PD). However, after an initial period of benefit, several limitations become apparent, including motor complications such as dyskinesia. Dyskinesia can severely affect patients' quality of life and increases healthcare resource use. Thus, delaying the need for levodopa, and therefore the onset of levodopa-induced dyskinesia, is important.
The aim of this study was to compare the cost effectiveness, from a UK healthcare payer perspective, of two antiparkinsonian treatment strategies in early PD: first-line monotherapy with rasagiline, a novel monoamine oxidase B inhibitor; and the non-ergoline dopamine receptor agonist pramipexole.
An economic Markov model was developed as a pragmatic tool to derive comparative information on the effectiveness, utility and costs of these two strategies over a 5-year period. Model input data were obtained from the TEMPO study for rasagiline and from a study by the Parkinson Study Group for pramipexole. Effectiveness outcomes were time to levodopa and time to levodopa-induced dyskinesia. Cost and quality-adjusted life-year (QALY) data were derived from published sources.
Rasagiline was the dominant strategy. Compared with pramipexole, use of the rasagiline strategy was estimated to reduce costs by 18% per patient over 5 years and was associated with an additional 10% delay in dyskinesia onset (0.41 years; 95% CI 0.27, 0.55). This strategy was also found to prolong the time to levodopa initiation by 25% through a gain of 0.83 levodopa-free years (95% CI 0.56, 1.1). In addition, use of the rasagiline strategy was found to generate a 5% gain in QALYs over 5 years compared with the pramipexole strategy (3.7 +/- 0.02 vs 3.51 +/- 0.03). Sensitivity analyses confirmed that the model was robust.
Rasagiline represents a cost-effective alternative to pramipexole in the treatment of early PD in the UK.
左旋多巴是治疗帕金森病（PD）症状最有效的药物。然而，在初期获益之后，一些局限性变得明显，包括运动并发症如异动症。异动症会严重影响患者的生活质量并增加医疗资源的使用。因此，推迟左旋多巴的使用需求，进而推迟左旋多巴诱发异动症的发生，是很重要的。
本研究的目的是从英国医疗保健支付方的角度，比较帕金森病早期两种抗帕金森治疗策略的成本效益：一线单药治疗使用新型单胺氧化酶B抑制剂雷沙吉兰；以及非麦角类多巴胺受体激动剂普拉克索。
开发了一个经济马尔可夫模型，作为一种实用工具，以获取这两种策略在5年期间的有效性、效用和成本的比较信息。模型输入数据来自雷沙吉兰的TEMPO研究以及帕金森研究组关于普拉克索的一项研究。有效性结局指标是开始使用左旋多巴的时间和出现左旋多巴诱发异动症的时间。成本和质量调整生命年（QALY）数据来自已发表的资料。
雷沙吉兰是主要策略。与普拉克索相比，使用雷沙吉兰策略估计在5年内每位患者的成本降低18%，并且异动症发作延迟额外10%（0.41年；95%可信区间0.27，0.55）。还发现该策略通过增加0.83年不使用左旋多巴的时间，使开始使用左旋多巴的时间延长25%（95%可信区间0.56，1.1）。此外，与普拉克索策略相比，使用雷沙吉兰策略在5年内QALY增加5%（3.7±0.02对3.51±0.03）。敏感性分析证实该模型是稳健的。
在英国，雷沙吉兰是治疗早期帕金森病时普拉克索的一种具有成本效益的替代药物。
