OBJECTIVES: We examined whether rasagiline, a once-daily irreversible monoamine oxidase type-B inhibitor indicated for treatment of early Parkinson’s disease, is a cost-effective first-line treatment strategy when compared with ropinirole XL, pramipexole, generic ropinirole, and first-line levodopa.
METHODS: We developed a 5-year Markov model to examine the cost-effectiveness of initiating early treatment of PD with rasagiline from a United States payer perspective. Comparator strategies included initiating therapy with ropinirole XL, pramipexole, generic ropinirole, or levodopa. Rasagiline was followed by either a dopamine agonist (DA) or levodopa. DA was followed by levodopa. Patients on a DA or levodopa could develop dyskinesias. Health state transitions occurred every 6 months. Transition probabilities were from clinical trial data. Drug costs, medical costs and utility weights were from published sources. One-way and probabilistic sensitivity analyses were performed. Costs and outcomes were discounted at 3% per year.
RESULTS: Over 5 years, first-line treatment with rasagiline was cost saving and more effective when compared to branded DAs and levodopa. Rasagiline was cost-effective versus generic ropinirole at $1,838 per quality-adjusted life-year (QALY): incremental costs +$239 and incremental QALYs +0.13. After five years compared to a DA, 23% and 50% fewer patients who initiated treatment with rasagiline were taking levodopa and experiencing dyskinesias respectively. Compared to first-line levodopa, 52% and 69% fewer patients starting rasagiline were taking levodopa and experiencing dyskinesias respectively.
CONCLUSIONS: Initiating early Parkinson’s disease therapy with rasagiline delayed treatment with levodopa, reduced dyskinesias, and appears to be cost-savings or cost-effective when compared to initiating therapy with other first-line therapies.
