Cabergoline versus levodopa monotherapy: a decision analysis.
Identifieur interne : 000B18 ( Ncbi/Curation ); précédent : 000B17; suivant : 000B19Cabergoline versus levodopa monotherapy: a decision analysis.
Auteurs : Antje M. Smala [Allemagne] ; E Annika Spottke ; Olaf Machat ; Uwe Siebert ; Dieter Meyer ; Rudolf Köhne-Volland ; Martin Reuther ; Janeen Duchane ; Wolfgang H. Oertel ; Karin B. Berger ; Richard C. DodelSource :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2003.
English descriptors
- KwdEn :
- Antiparkinson Agents (adverse effects), Antiparkinson Agents (economics), Antiparkinson Agents (therapeutic use), Cost-Benefit Analysis, Decision Making, Disease Progression, Ergolines (adverse effects), Ergolines (economics), Ergolines (therapeutic use), Female, Humans, Levodopa (adverse effects), Levodopa (economics), Levodopa (therapeutic use), Male, Markov Chains, Middle Aged, Parkinson Disease (diagnosis), Parkinson Disease (drug therapy), Parkinson Disease (economics), Severity of Illness Index.
- MESH :
- chemical , adverse effects : Antiparkinson Agents, Ergolines, Levodopa.
- chemical , economics : Antiparkinson Agents, Ergolines, Levodopa.
- chemical , therapeutic use : Antiparkinson Agents, Ergolines, Levodopa.
- diagnosis : Parkinson Disease.
- drug therapy : Parkinson Disease.
- economics : Parkinson Disease.
- Cost-Benefit Analysis, Decision Making, Disease Progression, Female, Humans, Male, Markov Chains, Middle Aged, Severity of Illness Index.
Abstract
We evaluated the incremental cost-effectiveness of cabergoline compared with levodopa monotherapy in patients with early Parkinson's disease (PD) in the German healthcare system. The study design was based on cost-effectiveness analysis using a Markov model with a 10-year time horizon. Model input data was based on a clinical trial "Early Treatment of PD with Cabergoline" as well as on cost data of a German hospital/office-based PD network. Direct and indirect medical and nonmedical costs were included. Outcomes were costs, disease stage, cumulative complication incidence, and mortality. An annual discount rate of 5% was applied and the societal perspective was chosen. The target population included patients in Hoehn and Yahr Stages I to III. It was found that the occurrence of motor complications was significantly lower in patients on cabergoline monotherapy. For patients aged >/=60 years of age, cabergoline monotherapy was cost effective when considering costs per decreased UPDRS score. Each point decrease in the UPDRS (I-IV) resulted in costs of euro;1,031. Incremental costs per additional motor complication-free patient were euro;104,400 for patients <60 years of age and euro;57,900 for patients >/=60 years of age. In conclusion, this decision-analytic model calculation for PD was based almost entirely on clinical and observed data with a limited number of assumptions. Although costs were higher in patients on cabergoline, the corresponding cost-effectiveness ratio for cabergoline was at least as favourable as the ratios for many commonly accepted therapies.
DOI: 10.1002/mds.10465
PubMed: 12889079
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Smala</name><affiliation wicri:level="3"><nlm:affiliation>Medical Economics Research Group (MERG), Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Medical Economics Research Group (MERG), Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName></affiliation></author><author><name sortKey="Spottke, E Annika" sort="Spottke, E Annika" uniqKey="Spottke E" first="E Annika" last="Spottke">E Annika Spottke</name></author><author><name sortKey="Machat, Olaf" sort="Machat, Olaf" uniqKey="Machat O" first="Olaf" last="Machat">Olaf Machat</name></author><author><name sortKey="Siebert, Uwe" sort="Siebert, Uwe" uniqKey="Siebert U" first="Uwe" last="Siebert">Uwe Siebert</name></author><author><name sortKey="Meyer, Dieter" sort="Meyer, Dieter" uniqKey="Meyer D" first="Dieter" last="Meyer">Dieter Meyer</name></author><author><name sortKey="Kohne Volland, Rudolf" sort="Kohne Volland, Rudolf" uniqKey="Kohne Volland R" first="Rudolf" last="Köhne-Volland">Rudolf Köhne-Volland</name></author><author><name sortKey="Reuther, Martin" sort="Reuther, Martin" uniqKey="Reuther M" first="Martin" last="Reuther">Martin Reuther</name></author><author><name sortKey="Duchane, Janeen" sort="Duchane, Janeen" uniqKey="Duchane J" first="Janeen" last="Duchane">Janeen Duchane</name></author><author><name sortKey="Oertel, Wolfgang H" sort="Oertel, Wolfgang H" uniqKey="Oertel W" first="Wolfgang H" last="Oertel">Wolfgang H. 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Dodel</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="ISSN">0885-3185</idno><imprint><date when="2003" type="published">2003</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antiparkinson Agents (adverse effects)</term><term>Antiparkinson Agents (economics)</term><term>Antiparkinson Agents (therapeutic use)</term><term>Cost-Benefit Analysis</term><term>Decision Making</term><term>Disease Progression</term><term>Ergolines (adverse effects)</term><term>Ergolines (economics)</term><term>Ergolines (therapeutic use)</term><term>Female</term><term>Humans</term><term>Levodopa (adverse effects)</term><term>Levodopa (economics)</term><term>Levodopa (therapeutic use)</term><term>Male</term><term>Markov Chains</term><term>Middle Aged</term><term>Parkinson Disease (diagnosis)</term><term>Parkinson Disease (drug therapy)</term><term>Parkinson Disease (economics)</term><term>Severity of Illness Index</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antiparkinson Agents</term><term>Ergolines</term><term>Levodopa</term></keywords><keywords scheme="MESH" type="chemical" qualifier="economics" xml:lang="en"><term>Antiparkinson Agents</term><term>Ergolines</term><term>Levodopa</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiparkinson Agents</term><term>Ergolines</term><term>Levodopa</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Cost-Benefit Analysis</term><term>Decision Making</term><term>Disease Progression</term><term>Female</term><term>Humans</term><term>Male</term><term>Markov Chains</term><term>Middle Aged</term><term>Severity of Illness Index</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">We evaluated the incremental cost-effectiveness of cabergoline compared with levodopa monotherapy in patients with early Parkinson's disease (PD) in the German healthcare system. The study design was based on cost-effectiveness analysis using a Markov model with a 10-year time horizon. Model input data was based on a clinical trial "Early Treatment of PD with Cabergoline" as well as on cost data of a German hospital/office-based PD network. Direct and indirect medical and nonmedical costs were included. Outcomes were costs, disease stage, cumulative complication incidence, and mortality. An annual discount rate of 5% was applied and the societal perspective was chosen. The target population included patients in Hoehn and Yahr Stages I to III. It was found that the occurrence of motor complications was significantly lower in patients on cabergoline monotherapy. For patients aged >/=60 years of age, cabergoline monotherapy was cost effective when considering costs per decreased UPDRS score. Each point decrease in the UPDRS (I-IV) resulted in costs of euro;1,031. Incremental costs per additional motor complication-free patient were euro;104,400 for patients <60 years of age and euro;57,900 for patients >/=60 years of age. In conclusion, this decision-analytic model calculation for PD was based almost entirely on clinical and observed data with a limited number of assumptions. Although costs were higher in patients on cabergoline, the corresponding cost-effectiveness ratio for cabergoline was at least as favourable as the ratios for many commonly accepted therapies.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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