Pramipexole v. Levodopa as Initial Treatment for Parkinson’s Disease: A Randomized Clinical-Economic Trial

Abstract

Purpose. To determine the 2-year incremental cost effectiveness of initial pramipexole treatment compared with initial levodopa treatment in patientswith early Parkinson’s disease (PD). Methods. 301 subjects with early PD were randomized to either pramipexole or levodopa and followed every 3 months over a 2-year period. Costs were assigned to patient collected health utilization data using a variety of methods. Health state preferences were estimated using the EuroQol. Results. Pramipexole strategy was an estimated $2,138 (SE = $1,182) more expensive than levodopa strategy. The incremental cost-effectiveness of pramipexole compared with levodopa was $106,900/QALY (EQ-5D), compared with pramipexole being dominated by levodopa using the EQVAS. Conclusions.Although considerable uncertainty exists in the 2-year cost-effectiveness of initial pramipexole compared with initial levodopa in the treatment of early PD, our estimates suggest that pramipexole may not be welfare enhancing during the first 2 years of treatment. If initial pramipexole results in long-term improvements in quality of life, its cost-effectiveness will become more favorable.