Cost of Quality of Life in Advanced Parkinson's Disease: Efficient Strategies for Disease Assessment.

Introduction: As Parkinson's disease progresses, symptoms develop that make it more difficult to control, either because of the presence of fluctuations despite adequate oral treatment, or because of the adverse effects caused by the continued use of levodopa, considered the gold standard. At this point in the course of the disease, there are different therapeutic alternatives that provide more continuous dopaminergic stimulation and help to improve this symptomatology: deep brain stimulation (Medtronic®: Percept™ Primary Cell (PC), Percept™ ReChargable (RC)), intestinal gel Levodopa/Carbidopa (Duodopa®) o Levodopa/Carbidopa/Entacapona (Lecigon®), as well as subcutaneous infusion of foslevodopa/foscarbidopa (Foslevodopa®) and continuous infusion of apomorphine (Dacepton®, Apo-Go®).

Objective: Pharmacoeconomic study of the different therapies for treating advanced Parkinson's disease in Spain.

Patients and methods: Based on a Markov model, the efficacy and costs of these therapies were compared, measuring life years gained (LYG) and quality-adjusted life years (QALY).

Results: Dacepton® (apomorphine) is the most cost-effective option with a cost of 20,782€/QALY (1€ = 1.0815 USD, 2025), compared to three times or more for the other therapies with Lecigon® (levodopa/carbidopa/entacapone) being the least cost-effective with a cost of 104,000€/QALY. Deep brain stimulation (DBS) and Duodopa® also proved to be effective options, but more costly than Dacepton®.

Conclusions: These results provide additional information on the efficiency of treatments that should inform decision-making in the management of advanced Parkinson's disease, thus enabling better resource management.