The Cost-Effectiveness of Opicapone Versus Entacapone as Adjuvant Therapy for Levodopa-Treated Individuals With Parkinson's Disease Experiencing End-of-Dose Motor Fluctuations.

Background: In levodopa-treated individuals with Parkinson's disease (PD) and end-of-dose motor fluctuations, the BIPARK-I randomized controlled trial (RCT) demonstrated that opicapone is noninferior to entacapone in reducing OFF-time. Furthermore, the BIPARK-II RCT demonstrated that opicapone is well tolerated and significantly reduces OFF-time compared with placebo. This study developed a cost-effectiveness model (CEM) of opicapone compared with entacapone from the perspective of the English National Health Service (NHS) and personal social services (PSS). Methods: The CEM used a Markov model with three health states, including "<25% OFF-time," "≥25% OFF-time," and "dead," as individuals spending less than 25% of their awake time experiencing OFF-time have previously been shown to have a significantly improved health-related quality of life and to accumulate fewer healthcare costs. The CEM had a 25-year time horizon, expressed costs as 2021/22 Great British Pounds (GBPs), and health outcomes as quality-adjusted life years (QALYs). Both costs and health outcomes were discounted at 3.5% annually, and a cost-effectiveness threshold of £20,000 per QALY was used. Probabilistic sensitivity analysis (PSA) considered parameter uncertainty. Results: The deterministic base case indicates that an individual treated with opicapone accrues fewer costs and more QALYs compared with each entacapone comparator and, therefore, is considered cost-effective. The PSA indicates that the probability that opicapone is cost-effective ranges from 87.2% to 98.0%, depending on the choice of entacapone comparator. Conclusions: Opicapone is cost-effective when compared with entacapone for levodopa-treated PD patients experiencing end-of-dose motor fluctuations. Trial Registration: ClinicalTrials.gov identifier: NCT01568073.