Advanced Parkinson’s Disease (PD)

Advanced Parkinson’s Disease (PD) is an incurable, progressive, neurological disease1 that develops gradually, eventually becoming severely disabling despite treatment2. PD is associated with various motor and non-motor symptoms (NMS). The severity of these motor and NMS increases with disease progression1.

The prevalence of PD ranges between 57 and 230 cases per 100,000 and increases with age3. Approximately 10% of all PD patients have advanced PD3. The mortality rate of general PD patients is approximately double that of the general population4 (ranging from 1.3 tot 5.7-fold higher), with disease severity, dementia and early age at onset being the most common predictor of death4.

With advancing disease both motor symptoms, and, in the later disease stages the NMS of mood alterations and apathy, are associated with reduced HRQoL. Once patients reach the advanced stages of PD, their overall health status and HRQoL becomes increasingly poor6.

The economic burden of PD is substantial and increases with disease progression due to the cost, associated with managing motor complications and NMS and the need for care including medical care, home care and/or long-term care2,7.

The treatment goals for patients with advanced PD are to optimize treatment to reduce disability, relieve of symptoms and reduce distress of patients an carers and allow the patient to continue to have active life for as long as possible. However treatment options in advanced PD are limited; therapies that are available tend to have strict eligibility criteria, limited efficacy, and the potential for serious adverse events (AE). The therapies in advanced PD are deep brain stimulation (DBS), Apomorphine Continuous Infusion (ACI) and Levodopa Carbidopa Intestinal Gel (LCIG).

All future new treatments for advanced PD will need to submit an economic assessment for reimbursement purposes. HTA bodies will want to see an assessment of the new therapy by comparing it to the current standard of care. In order to be prepared for new therapies to come in the near future it is critical to assess the current cost-effectiveness models used in the current standard of care treatment for advanced PD. To my knowledge, no such information has been systematically reviewed to date.

Therefore the purpose of this study is to summarize the published cost-effectiveness models used for patients with advanced PD receiving DBS, ACI or LCIG. More specifically, by means of a systematically review of the literature the aim is to provide an overview of the model structure, source data, modeling approaches and findings of the identified studies. The findings will be critically assessed, addressing; the consistency and sensitivity of the modelling approaches, the ICER’s sensitivity.

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