Second-Line Therapies in Parkinson Disease Aim to Maximize Outcomes, but at a Price

According to study findings published in Parkinson Disease, continuous duodenal levodopa/carbidopa infusion (CDLCI) was indicated as the most expensive second-line therapy in advanced stage Parkinson disease (PD) compared with deep brain stimulation (DBS) and continuous subcutaneous apomorphine infusion (CSAI).

As the study authors highlight, PD can have a significant impact on patients, families, and caregivers. Focusing on the financial burden of PD, the prevalence of OFF periods, which is characterized by the reappearance or worsening of motor and/or nonmotor symptoms, has been shown to expose caregivers to greater financial burden.

Although there is no cure, PD has several second-line therapies that work to improve the quality of life among those affected. These therapies, in combination with other factors such as technological advances and innovations in social and health benefits, have led to improvements in survival rates of PD, with more patients living longer and subsequently being treated for more advanced disease stages.

Because advanced stage PD treatments are more invasive, the researchers sought to analyze the costs of notable second-line therapies used in this phase, such as DBS, CDLCI, and CSAI.

“It is necessary to improve methodologies of cost analysis and transform data into powerful patient-level information. However, there is a far greater focus on measuring health outcomes than measuring costs,” said the study authors.

The study utilized a bottom-up retrospective approach on real-world data (RWD) derived from an integrated health care organization in Spain from 2016 to 2018 (n = 105; 57% treated with DBS; 25.7% treated with CDLCI; 17.3% treated with CSAI). Results were based on the annual cost over 3 years and the projected cost for an additional 2 years of each therapy.

In the study results, the total 5-year costs, converted to US dollars, were $58,391.55 for DBS; $187,178.42 for CSAI; and $228,403.73 for CDLCI. Moreover, the researchers detailed that for DBS, the largest costs are incurred during the implantation procedure and when the battery is changed.

“Currently, measuring the concept of 'value' in health care, which includes maximizing outcomes that are important to people at the lowest possible cost, is increasingly seen as being the key for transforming health care delivery towards more efficient and sustainable models,” said the study authors. As mechanisms to measure cost of therapies continue to evolve, “this research intended to fill this gap by providing a comparative RWD cost analysis of second-line therapies for patients with PD.”

Noting limitations, the researchers referenced the small study cohort as a potential complication.

Reference

Gomez-Inhiesto E, Acaiturri-Ayesta MT, Ustarroz-Aguirre I, et al. Direct cost of Parkinson disease: a real-world data study of second-line therapies. Parkinsons Dis. Published online May 12, 2020. doi:10.1155/2020/9106026