Licensed Subcutaneous Infusion Therapies in Advanced Parkinson's Disease: An Indirect Treatment Comparison and Cost-Minimisation Analysis.

IF 4.8 3区医学 Q1 CLINICAL NEUROLOGY

Neurology and Therapy Pub Date : 2025-10-01 Epub Date: 2025-07-08 DOI:10.1007/s40120-025-00789-9

Marc Vérin, Ángel Sesar, Bharat Amlani, Niall Smith, Konstantinos Kipentzoglou, Stephen Montgomery, Alice Reading, Andrei Karlsson, Anna Willis, Andrew J Lees

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Abstract

Introduction: Parkinson's disease is the second most common neurodegenerative disorder. In advanced Parkinson's disease, subcutaneous (SC) infusion therapies represent minimally invasive and reversible treatment options. In the United Kingdom (UK), licensed SC infusion therapies include apomorphine and foslevodopa-foscarbidopa; both represent effective and generally well-tolerated therapies, although uncertainties regarding their relative efficacy, safety and costs remain.

Methods: The relative efficacy and safety of apomorphine and foslevodopa-foscarbidopa was assessed via Bucher indirect treatment comparison (ITC) of TOLEDO (NCT02006121) and M15-736 (NCT04380142) data, with findings used to support a cost-minimisation analysis (CMM). Thirteen outcomes were evaluated. Efficacy and safety outcomes were measured as mean differences and risk differences, respectively. The CMM, conducted from a UK healthcare payer perspective, considered treatment acquisition and concomitant therapy costs over a 6.34-year horizon (obtained from a published observational study).

Results: Bucher ITC results provided evidence for a comparable efficacy for apomorphine and foslevodopa-foscarbidopa in advanced Parkinson's disease. ITCs also indicated comparable safety, although a trend in favour of apomorphine was identified for hallucinations and most infusion site reactions assessed. The CMM demonstrated a clear per-patient cost benefit for apomorphine versus foslevodopa-foscarbidopa (£120,173.70), primarily driven by lower drug acquisition costs.

Conclusion: The main difference between UK licensed SC infusion therapies for advanced Parkinson's disease relates to cost as opposed to clinical outcome, with some evidence for improved tolerability of apomorphine. This supports the continued use of apomorphine as first-line SC infusion treatment for advanced Parkinson's disease in UK clinical practice.

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晚期帕金森病的许可皮下输注疗法：间接治疗比较和成本最小化分析。

帕金森病是第二常见的神经退行性疾病。在晚期帕金森病中，皮下（SC）输注治疗是微创和可逆的治疗选择。在英国，获得许可的SC输注疗法包括阿波啡和foslevodopa-foscarbidopa；尽管它们的相对疗效、安全性和成本仍然存在不确定性，但这两种疗法都是有效且通常耐受性良好的疗法。方法：通过TOLEDO （NCT02006121）和M15-736 （NCT04380142）的Bucher间接治疗比较（ITC）数据，评估阿波吗啡和foslevodopa-foscarbidopa的相对疗效和安全性，结果用于支持成本最小化分析（CMM）。评估了13项结果。疗效和安全性结果分别以平均差异和风险差异来衡量。CMM是从英国医疗保健支付者的角度进行的，考虑了6.34年的治疗获得和伴随治疗费用（来自一项已发表的观察性研究）。结果：Bucher ITC结果为阿波啡和fosleovdopa -foscarbidopa治疗晚期帕金森病的疗效相当提供了证据。ITCs也显示出相当的安全性，尽管有一种倾向于阿波啡治疗幻觉的趋势，并评估了大多数输液部位的反应。CMM显示阿波啡相对于foslevodopa-foscarbidopa有明显的每名患者成本优势（120,173.70英镑），主要是由于较低的药物获取成本。结论：英国许可的SC输注治疗晚期帕金森病的主要区别在于成本而不是临床结果，有一些证据表明阿波啡的耐受性得到改善。这支持在英国临床实践中继续使用阿波啡作为晚期帕金森病的一线SC输注治疗。

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来源期刊

Neurology and Therapy CLINICAL NEUROLOGY-

CiteScore

5.40

自引率

8.10%

发文量

103

审稿时长

6 weeks

期刊介绍： Aims and Scope Neurology and Therapy aims to provide reliable and inclusive, rapid publication for all therapy related research for neurological indications, supporting the timely dissemination of research with a global reach, to help advance scientific discovery and support clinical practice. Neurology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of neurological and psychiatric therapies, (also covering surgery and devices). Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial designs, communications and letters. 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