van Boven Job F M, Novak Annoesjka, Driessen Maurice T, Boersma Cornelis, Boomsma Maarten M, Postma Maarten J
Department of Pharmacy, Unit of PharmacoEpidemiology and PharmacoEconomics (PE2), University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands,
Drugs Aging. 2014 Mar;31(3):193-201. doi: 10.1007/s40266-013-0150-4.
By using the findings obtained from the PREPARED study, we aimed to estimate the cost effectiveness of ropinirole prolonged release (PR) [Requip-Modutab(®)] in Parkinson's disease (PD) versus ropinirole immediate release (IR). In the PREPARED study, ropinirole PR provided a significantly greater improvement in time spent 'off' than ropinirole IR when used as an add-on to levodopa.
A health state transition model was developed-based on Hoehn and Yahr (HY) stages in PD-to compare the two treatment strategies. The Markov model included the following treatment-related aspects: (i) rate of disease progression; (ii) rates of dyskinesia; and (iii) medication adherence.
In our approach, the base-case analysis showed a favourable pharmacoeconomic profile of ropinirole PR versus ropinirole IR. In particular, general cost savings were estimated combined with modest gains in quality of life, due to reduced disease progression and lower dyskinesia rates. Sensitivity analyses showed that this result was rather robust for varying parameters deterministically, although cost savings were lost in some instances. In particular, the treatment benefits of lower dyskinesia rates and improved adherence influenced the cost-effectiveness outcome. Nonetheless, the cost effectiveness remained acceptable within the limits that were investigated. Probabilistic sensitivity analysis revealed that the probability of accepting PR over IR exceeded 95 % for all relevant 'willingness-to-pay' thresholds.
The results of our study indicate a high likelihood of ropinirole PR being cost saving or at least being considered cost effective for use in the Netherlands. However, claims included in our model regarding dyskinesia and improved medication adherence should be further supported by data from daily practice.
通过利用帕金森病进展评估（PREPARED）研究的结果，我们旨在评估与罗匹尼罗速释片（IR）相比，罗匹尼罗缓释片（PR）[Requip-Modutab(®)]治疗帕金森病（PD）的成本效益。在PREPARED研究中，当作为左旋多巴的附加治疗使用时，罗匹尼罗PR在“关”期时间方面的改善显著大于罗匹尼罗IR。
基于帕金森病的 Hoehn 和 Yahr（HY）分期开发了一种健康状态转换模型，以比较两种治疗策略。马尔可夫模型包括以下与治疗相关的方面：（i）疾病进展率；（ii）异动症发生率；（iii）药物依从性。
在我们的研究方法中，基础病例分析显示罗匹尼罗PR相对于罗匹尼罗IR具有良好的药物经济学特征。特别是，由于疾病进展减缓和异动症发生率降低，估计总体成本节省，同时生活质量有适度提高。敏感性分析表明，尽管在某些情况下成本节省有所损失，但该结果对于确定性变化的参数相当稳健。特别是，较低的异动症发生率和改善的依从性带来的治疗益处影响了成本效益结果。尽管如此，在所研究的范围内，成本效益仍然可以接受。概率敏感性分析显示，对于所有相关的“支付意愿”阈值，接受PR而非IR的概率超过95%。
我们的研究结果表明，罗匹尼罗PR在荷兰极有可能节省成本，或至少被认为具有成本效益。然而，我们模型中关于异动症和改善药物依从性的说法应得到来自日常实践数据的进一步支持。
