Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson's disease in the UK and Germany

Background: Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting similar to 5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC). Methods: A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3-5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider's perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon. Results: UK lifetime costs associated with CSAI amounts to 78,251.49 pound and generates 2.85 QALYs and 6.28 LYs ((sic)104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are 130,011.34 pound, achieves 3.06 QALYs and 6.93 LYs ((sic)175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was 244,684.69 pound ((sic)272,914.58). Costs for DBS are 87,730.22 pound, associated with 2.75 QALYs and 6.38 LYs ((sic)105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are 76,793.49; pound 2.62 QALYs and 5.76 LYs were reached ((sic)90,011.91, 2.73 QALYs and 6 LYs for Germany). Conclusions: From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.