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. 2021;11(2):475-489.
doi: 10.3233/JPD-202348.

Cost-Effectiveness of Device-Aided Therapies in Parkinson's Disease: A Structured Review

Katarzyna Smilowska  1   2 , Daniel J van Wamelen  2   3   4 , Tomasz Pietrzykowski  5 , Alexander Calvano  3   4 , Carmen Rodriguez-Blazquez  6 , Pablo Martinez-Martin  6 , Per Odin  7 , K Ray Chaudhuri  3   4
Affiliations

Cost-Effectiveness of Device-Aided Therapies in Parkinson's Disease: A Structured Review

Katarzyna Smilowska et al. J Parkinsons Dis. 2021.

Abstract

Background: Despite optimal dopaminergic treatment most patients in moderate to advanced stages of Parkinson's disease (PD) experience progressively increasing disabilities, necessitating a shift from oral medication to device-aided therapies, including deep brain stimulation (DBS), intrajejunal levodopa-carbidopa infusion (IJLI), and continuous subcutaneous apomorphine infusion (CSAI). However, these therapies are costly, limiting their implementation.

Objectives: To perform a systematic review on cost-effectiveness analyses for device-aided therapies in PD.

Methods: References were identified by performing a systematic search in the PubMed and Web of Science databases in accordance with the PRISMA statement. In the absence of universal cost-effectiveness definitions, the gross domestic product per capita (GDP) in the country where a study was performed was used as a cut-off for cost-effectiveness based on cost per quality adjusted life year (QALY) gained.

Results: In total 30 studies were retrieved. All device-aided therapies improved quality of life compared to best medical treatment, with improvements in QALYs between 0.88 and 1.26 in the studies with long temporal horizons. For DBS, nearly all studies showed that cost per QALY was below the GDP threshold. For infusion therapies only three studies showed a cost per QALY below this threshold, with several studies with long temporal horizons showing costs below or near the GDP threshold.

Conclusion: Of the device-aided therapies, DBS can be considered cost-effective, but the majority of infusion therapy studies showed that these were less cost-effective. However, long-term use of the infusion therapies appears to improve their cost-effectiveness and in addition, several strategies are underway to reduce these high costs.

Keywords: Parkinson’s disease; continuous subcutaneous apomorphine infusion; cost-effectiveness; deep brain stimulation; levodopa-carbidopa intestinal gel; quality adjusted life year.

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Conflict of interest statement

No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work.

Figures

Fig. 1
Fig. 1
Study selection process.
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