OBJECTIVES: Parkinson’s disease (PD) affects approximately 1 million people in the United States. A common PD treatment is levodopa; however, motor fluctuations and dyskinesias are common side effects. This model examines whether rasagiline, a once daily irreversible monoamine oxidase type-B inhibitor for treatment of early PD, offers a cost-effective treatment strategy and delays the initiation of levodopa when compared with ropinirole extended release (ropinirole), a once-daily dopamine agonist.
METHODS: A five-year Markov model was utilized to examine the cost-effectiveness of initiating early treatment of PD with rasagiline versus ropinirole from a managed care perspective. Strategies included initial therapy with rasagiline, followed by either ropinirole or levodopa, versus initiating therapy with ropinirole, followed by levodopa. Patients could transition therapy every six months; patients on levodopa could develop dyskinesias. Rasagiline transition probabilities obtained from the TVP-1012 in Early Monotherapy for Parkinson’s Disease Outpatients (TEMPO) trial. Medical costs and utility weights were from published literature. Drug costs were from Red Book. Model outcomes included time to levodopa treatment, time to levodopa-induced dyskinesias, life-years, quality-adjusted life-years (QALY), and incremental cost per QALY. One-way and probabilistic sensitivity analyses were performed.
RESULTS: Compared to initiating treatment with ropinirole, treatment initiation with rasagiline was associated with a delay in the time to treatment with levodopa (4.45 months) and subsequently the time to levodopa-induced dyskinesia (1.00 months). Rasagiline initiation was also associated with lower costs (-$1660) and higher expected QALYs (+0.0608) over 5 years, which is dominant. The model was most sensitive to clinical efficacy and drug costs.
CONCLUSIONS: Initiating treatment with rasagiline was found to delay treatment with levodopa and subsequent dyskinesias, compared to initiating treatment with ropinirole, and appears to be a cost-saving and clinically-effective treatment strategy.
