Cost-effectiveness of rasagiline compared with first-line early parkinson disease therapies
Objectives: To examine whether rasagiline, a once-daily irreversible monoamine oxidase type-B inhibitor indicated for treatment of early Parkinson disease (PD), is a cost-effective fi rst-line treatment strategy compared with 4 other common fi rst-line treatment strategies from a US managed care perspective.
Study Design: A 5-year Markov model to examine the costeffectiveness of initiating early treatment of PD with rasagiline. Comparator strategies included initiating therapy with ropinirole XL, pramipexole, generic ropinirole, or levodopa.
Methods: Rasagiline was followed by either a dopamine agonist (DA) or levodopa. A DA was followed by levodopa. Patients on a DA or levodopa could develop dyskinesias. Health-state transitions occurred every 6 months. Transition probabilities were estimated from clinical trial data. Drug costs, medical costs, and utility weights were from published sources. One-way and probabilistic sensitivity analyses were performed. Costs and outcomes were discounted at 3% per year.
Results: After 5 years, compared with patients who initiated therapy with a DA, 23% fewer patients who initiated treatment with rasagiline were taking levodopa and 38% fewer patients were experiencing dyskinesias. Compared with patients receiving fi rstline levodopa, 73% fewer patients were experiencing dyskinesias. Over 5 years, treatment initiation with rasagiline was cost saving compared with ropinirole XL, pramipexole, and levodopa ($3141, $833, and $571, respectively). Compared with generic ropinirole, rasagiline had a cost-effectiveness ratio of $25,939 per qualityadjusted life-year.
Conclusions: Initiating treatment with rasagiline delays treatment with levodopa, delays onset of dyskinesias, and was cost saving or cost-effective when compared with initiating therapy with other first-line therapies in this model.