Cost analysis of ropinirole versus levodopa in the treatment of Parkinson's disease
Identifieur interne : 002F43 ( Main/Exploration ); précédent : 002F42; suivant : 002F44Cost analysis of ropinirole versus levodopa in the treatment of Parkinson's disease
Auteurs : Michael Iskedjian [Canada] ; Thomas R. Einarson [Canada]Source :
- PharmacoEconomics : (Auckland) [ 1170-7690 ] ; 2003.
Descripteurs français
- Pascal (Inist)
- Wicri :
English descriptors
- KwdEn :
- Adult, Agonist, Antiparkinson Agents (economics), Antiparkinson Agents (therapeutic use), Antiparkinson agent, Benserazide (economics), Benserazide (therapeutic use), Canada, Caregivers (economics), Chemotherapy, Comparative study, Cost Savings, Cost analysis, Cost efficiency analysis, D2 Dopamine receptor, Dopamine Agonists (economics), Dopamine Agonists (therapeutic use), Dopamine agonist, Drug Costs, Health Care Costs, Health economy, Human, Humans, Indoles (economics), Indoles (therapeutic use), Levodopa, Levodopa (economics), Levodopa (therapeutic use), Middle Aged, Parkinson Disease (drug therapy), Parkinson Disease (economics), Parkinson disease, Ropinirole, Treatment, Treatment Outcome.
- MESH :
- chemical , economics : Antiparkinson Agents, Benserazide, Dopamine Agonists, Indoles, Levodopa.
- chemical , therapeutic use : Antiparkinson Agents, Benserazide, Dopamine Agonists, Indoles, Levodopa.
- geographic : Canada.
- drug therapy : Parkinson Disease.
- economics : Caregivers, Parkinson Disease.
- Adult, Cost Savings, Drug Costs, Health Care Costs, Humans, Middle Aged, Treatment Outcome.
Abstract
Background: Not all patients with Parkinson's disease (PD) respond to levodopa and others develop dyskinesias. Ropinirole, a dopamine agonist, is associated with fewer dyskinesias than levodopa. Objective: To examine the economic impact of reducing dyskinesias using ropinirole instead of levodopa plus benserazide in PD was examined. The research question addressed was: is the added cost of ropinirole offset by savings due to avoided cases of dyskinesia? Methods: A cost-minimisation analysis was performed from both the societal and Ministry of Health (MoH) of Ontario, Canada perspectives, using 5-year data from a study of dyskinesia outcomes comparing ropinirole with levodopa plus benserazide. A predictive model was developed to capture resource utilisation over 5 years, such as medication costs, medical consultations, hospital admissions, nursing home admissions, caregiver time and productivity loss. The model was based on a previously reported clinical trial which determined dyskinesia rates to be 20% for ropinirole and 45% for levodopa. Standard costing lists were used, and costs were discounted at various rates. Constant 1999 Canadian dollars ($Can) were applied, and no increases were assumed over the time horizon of the analysis. A multivariate sensitivity analysis with changes in key parameters was also performed. Results: From a societal perspective, ropinirole was cost saving. From the MoH perspective, the analysis yielded an incremental expected daily cost/patient of $Can4.41 for substituting levodopa plus benserazide with ropinirole. Ropinirole resulted in daily savings/patient of $Can0.17 in non-drug healthcare costs. In the sensitivity analysis, the direction of results did not change despite changes of 15 to 20% in key parameters, suggesting robustness of the model. Conclusions: From the societal perspective, in comparison with levodopa plus benserazide, the added cost of ropinirole is offset by savings due to avoided cases of dyskinesia.
Affiliations:
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Le document en format XML
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<term>Agonist</term>
<term>Antiparkinson Agents (economics)</term>
<term>Antiparkinson Agents (therapeutic use)</term>
<term>Antiparkinson agent</term>
<term>Benserazide (economics)</term>
<term>Benserazide (therapeutic use)</term>
<term>Canada</term>
<term>Caregivers (economics)</term>
<term>Chemotherapy</term>
<term>Comparative study</term>
<term>Cost Savings</term>
<term>Cost analysis</term>
<term>Cost efficiency analysis</term>
<term>D2 Dopamine receptor</term>
<term>Dopamine Agonists (economics)</term>
<term>Dopamine Agonists (therapeutic use)</term>
<term>Dopamine agonist</term>
<term>Drug Costs</term>
<term>Health Care Costs</term>
<term>Health economy</term>
<term>Human</term>
<term>Humans</term>
<term>Indoles (economics)</term>
<term>Indoles (therapeutic use)</term>
<term>Levodopa</term>
<term>Levodopa (economics)</term>
<term>Levodopa (therapeutic use)</term>
<term>Middle Aged</term>
<term>Parkinson Disease (drug therapy)</term>
<term>Parkinson Disease (economics)</term>
<term>Parkinson disease</term>
<term>Ropinirole</term>
<term>Treatment</term>
<term>Treatment Outcome</term>
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<term>Benserazide</term>
<term>Dopamine Agonists</term>
<term>Indoles</term>
<term>Levodopa</term>
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<term>Benserazide</term>
<term>Dopamine Agonists</term>
<term>Indoles</term>
<term>Levodopa</term>
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<term>Parkinson Disease</term>
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<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Cost Savings</term>
<term>Drug Costs</term>
<term>Health Care Costs</term>
<term>Humans</term>
<term>Middle Aged</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Ropinirole</term>
<term>Lévodopa</term>
<term>Antiparkinsonien</term>
<term>Parkinson maladie</term>
<term>Chimiothérapie</term>
<term>Traitement</term>
<term>Homme</term>
<term>Economie santé</term>
<term>Analyse coût</term>
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<term>Stimulant dopaminergique</term>
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<front><div type="abstract" xml:lang="en">Background: Not all patients with Parkinson's disease (PD) respond to levodopa and others develop dyskinesias. Ropinirole, a dopamine agonist, is associated with fewer dyskinesias than levodopa. Objective: To examine the economic impact of reducing dyskinesias using ropinirole instead of levodopa plus benserazide in PD was examined. The research question addressed was: is the added cost of ropinirole offset by savings due to avoided cases of dyskinesia? Methods: A cost-minimisation analysis was performed from both the societal and Ministry of Health (MoH) of Ontario, Canada perspectives, using 5-year data from a study of dyskinesia outcomes comparing ropinirole with levodopa plus benserazide. A predictive model was developed to capture resource utilisation over 5 years, such as medication costs, medical consultations, hospital admissions, nursing home admissions, caregiver time and productivity loss. The model was based on a previously reported clinical trial which determined dyskinesia rates to be 20% for ropinirole and 45% for levodopa. Standard costing lists were used, and costs were discounted at various rates. Constant 1999 Canadian dollars ($Can) were applied, and no increases were assumed over the time horizon of the analysis. A multivariate sensitivity analysis with changes in key parameters was also performed. Results: From a societal perspective, ropinirole was cost saving. From the MoH perspective, the analysis yielded an incremental expected daily cost/patient of $Can4.41 for substituting levodopa plus benserazide with ropinirole. Ropinirole resulted in daily savings/patient of $Can0.17 in non-drug healthcare costs. In the sensitivity analysis, the direction of results did not change despite changes of 15 to 20% in key parameters, suggesting robustness of the model. Conclusions: From the societal perspective, in comparison with levodopa plus benserazide, the added cost of ropinirole is offset by savings due to avoided cases of dyskinesia.</div>
</front>
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