Cost-Effectiveness of Pergolide Compared to Bromocriptine in the Treatment of Parkinson's Disease: A Decision-Analytic Model
Identifieur interne : 001971 ( Main/Exploration ); précédent : 001970; suivant : 001972Cost-Effectiveness of Pergolide Compared to Bromocriptine in the Treatment of Parkinson's Disease: A Decision-Analytic Model
Auteurs : Peter Davey [Australie, Niger] ; Narayan Rajan [Australie] ; Michael Lees [Australie] ; Michael Aristides [Australie]Source :
- Value in Health [ 1098-3015 ] ; 2001.
Abstract
Objective To develop a decision-analytic model to assess the cost-effectiveness of pergolide versus bromocriptine in the treatment of Parkinson's disease (PD).Methods A Markov decision-analytic model is used to examine cost-effectiveness. The model ran for 20 cycles of 6 months' duration, and the patients progress through six stages: Hoehn-Yahr stages 15 and death. The transitional probabilities for each stage are derived from a 12-year longitudinal study of patients with PD. The costs in the model are derived from an expert panel containing six Australian neurologists. A review of the randomized controlled trials comparing the efficacy and safety of pergolide versus bromocriptine was undertaken. Five studies were identified, with four showing that pergolide offers superior efficacy when compared to bromocriptine. The Mizuno et al. (1995) study was the largest of the controlled trials and also measured patient Hoehn-Yahr status before and after treatment. This was identified as the most appropriate source of relative efficacy data for the model. The model examined various scenarios based on alternate durations of superior clinical benefit with pergolide compared to bromocriptine. The main analysis assumed that patients in each arm of the model would have identical Hoehn-Yahr status by the fifth year. Sensitivity analysis was used to determine cost-effectiveness in the case where the therapeutic benefit was of a shorter duration.Results The Mizuno study indicates that an additional 19.09 of patients improved by at least one stage on pergolide over bromocriptine, with an odds ratio of 2.26 (p < .01). The total health care cost per patient over the 10-year period was 46,323 in the pergolide treatment arm and 47,351 in the bromocriptine treatment arm, an incremental saving of 1028. Patients also spent extra time in Hoehn-Yahr stages 1, 2, and 3. In sensitivity analyses, when the benefit from pergolide expired between 6 months and 5 years after treatment cessation, cost savings ranged from 68 to 2535.Conclusion Pergolide is cost saving and more efficacious than bromocriptine, and is therefore cost-effective.
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DOI: 10.1046/j.1524-4733.2001.44039.x
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The model ran for 20 cycles of 6 months' duration, and the patients progress through six stages: Hoehn-Yahr stages 15 and death. The transitional probabilities for each stage are derived from a 12-year longitudinal study of patients with PD. The costs in the model are derived from an expert panel containing six Australian neurologists. A review of the randomized controlled trials comparing the efficacy and safety of pergolide versus bromocriptine was undertaken. Five studies were identified, with four showing that pergolide offers superior efficacy when compared to bromocriptine. The Mizuno et al. (1995) study was the largest of the controlled trials and also measured patient Hoehn-Yahr status before and after treatment. This was identified as the most appropriate source of relative efficacy data for the model. The model examined various scenarios based on alternate durations of superior clinical benefit with pergolide compared to bromocriptine. The main analysis assumed that patients in each arm of the model would have identical Hoehn-Yahr status by the fifth year. Sensitivity analysis was used to determine cost-effectiveness in the case where the therapeutic benefit was of a shorter duration.Results The Mizuno study indicates that an additional 19.09 of patients improved by at least one stage on pergolide over bromocriptine, with an odds ratio of 2.26 (p < .01). The total health care cost per patient over the 10-year period was 46,323 in the pergolide treatment arm and 47,351 in the bromocriptine treatment arm, an incremental saving of 1028. Patients also spent extra time in Hoehn-Yahr stages 1, 2, and 3. In sensitivity analyses, when the benefit from pergolide expired between 6 months and 5 years after treatment cessation, cost savings ranged from 68 to 2535.Conclusion Pergolide is cost saving and more efficacious than bromocriptine, and is therefore cost-effective.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Niger</li></country><settlement><li>Sydney</li></settlement></list><tree><country name="Australie"><noRegion><name sortKey="Davey, Peter" sort="Davey, Peter" uniqKey="Davey P" first="Peter" last="Davey">Peter Davey</name></noRegion><name sortKey="Aristides, Michael" sort="Aristides, Michael" uniqKey="Aristides M" first="Michael" last="Aristides">Michael Aristides</name><name sortKey="Davey, Peter" sort="Davey, Peter" uniqKey="Davey P" first="Peter" last="Davey">Peter Davey</name><name sortKey="Lees, Michael" sort="Lees, Michael" uniqKey="Lees M" first="Michael" last="Lees">Michael Lees</name><name sortKey="Rajan, Narayan" sort="Rajan, Narayan" uniqKey="Rajan N" first="Narayan" last="Rajan">Narayan Rajan</name></country><country name="Niger"><noRegion><name sortKey="Davey, Peter" sort="Davey, Peter" uniqKey="Davey P" first="Peter" last="Davey">Peter Davey</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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