Table 2.
Cost-effectiveness of advanced therapies in Parkinson’s disease
| Deep brain stimulation | |||||||||||||||
| Study | Country | Type of Study | Cost of Intervention | QALYs intervention | Comparator | Cost of Comparator | QALYs Comparator | Temporal Horizon | Discount Rate | ICER | Difference in QALY | Incremental Cost | GDP/capita threshold | Cost-effectve?* | Sponsor bias? |
| Tomaszewski and Holloway, 2001 [35] | United States | CUA | $452,000(€ 502,222) | 7.8 | BMT | $417,000(€ 463,333) | 7.08 | Lifetime | 3% | $49,194(€ 54,660) | 0.72 | $35,000(€ 38,889) | $37,100 | Yes | Not sponsor funded |
| Gerzeli et al., 2002 [69] | Italy | Costs | € 20,033 | NA | BMT | € 8,976 | NA | 1y | NA | NS | NA | € 11,057 | $28.716 | Yes | Sponsor funded |
| Meissner et al., 2005 [70] | Germany | CEA | € 28,305 | NA | BMT | € 15,991 | NA | 2 y | 5% | NS | NA | € 12,314 | $32,237 | Yes | Not sponsor funded |
| Valldeoriola et al., 2007 [27] | Spain | CUA | € 27,614 | 0.7611 | BMT | € 20,013 | 0.5401 | 1 y | NA | € 34,389 | 0.221 | € 7,601 | $32,429 | Yes | Not sponsor funded |
| Dams et al., 2013 [34] | Germany | CUA | € 133,174 | 11.62 | BMT | € 126,180 | 10.58 | Lifetime | 3% | € 6,677 | 1.05 | € 6,994 | $44,994 | Yes | Not sponsor funded |
| Valldeoriola et al., 2013 [32] | Spain | CEA | € 103,730 | NA | IJLI | € 247,918 | NA | 5 y | NS | NS | NA | € –144,188 | N/A | N/A | Sponsor |
| CSAI | € 160,150 | NA | NA | € –56,420 | N/A | N/A | funded | ||||||||
| Eggington et al., 2014 [31] | United Kingdom | CUA | £ 68,970 (€ 101,426) | 2.21 | BMT | £48,243(€ 70,946) | 1.21 | 5 y | 3.5% | £20,678 (€ 30,409) | 1,002 | £20,727 (€ 30,481) | $41,269 | Yes | Sponsor funded |
| Zhu et al., 2014 [29] | China | CUA | $398,110 (€ 299,331) | 0.855 | BMT | $107,258 (€ 80,645) | 0.5 | 2 y | 3% | $24,868 (€ 18,698) | 0.355 | $1,347 (€ 1,013) | $13,459 | Yes | Not sponsor funded |
| Walter & Odin,2015 [24] | UK | CEA | £87,730 (€ 120,178) | 2.75 | BMT | £76,793(€ 105,196) | 2.62 | 3 years | 3.5% | NS | 0.13 | £10,937(€ 14,982) | $42,522 | Yes | Sponsor funded |
| Germany | CEA | € 105,737 | 2.85 | BMT | € 90,012 | 2.73 | 3 years | 3% | NS | 0.12 | € 15,725 | $47,684 | Yes | ||
| Pietzsch et al., 2016 [37] | USA | CEA | $130,510(€ 117,577) | 3.19 | BMT | $91,026 (€ 82,005) | 1.50 | 10y | 3% | $23,404 (€ 21,085) | 1.69 | $19,571 (€ 17,632) | $57,884 | Yes | Sponsor funded |
| Fundament et al., 2016 [28] | UK | CEA | £73,077 (€ 89,118) | 6.69 | BMT | £46,278 (€ 56,437) | 5.35 | 15y | 3,5% | £19,887 (€ 24,252) | 1.34 | £26,799(€ 32,682) | $44,138 | Yes | Sponsor funded |
| Kawamoto et al., 2016 [71] | Japan | CEA | $144,600(€ 130,270) | NS | BMT | NS | NS | NS | NS | NS | 6.7 | $25,600(€ 23,063) | $39,990 | Yes | Not sponsor funded |
| Dams et al., 2016 [36] | Germany | CEA | € 151,800 | 13.84 | BMT | € 115,400 | 12.25 | Lifetime | 3% | € 22,710 | 1.59 | € 36,400 | $50,564 | Yes | Sponsor funded |
| Vivancos-Matellano et al., 2016 [25]* review | Spain | CEA | € 89,477 | 2.80 | IJLI | € 234,643 | 3.12 | 5 years | 3.5% | NS | –0.32 | –€ 145,166 | N/A | N/A | Not |
| CSAI | € 110,348 | 2.89 | € 245,541 | –0.09 | –€ 20,817 | N/A | N/A | sponsor funded | |||||||
| McIntosh et al., 2016 [30] | UK | CEA | £19,069 (€ 23,255) | 0.0286 | BMT | £9,813 (€ 11,967) | 0.0088 | 1 year | 3.5% | £468,528 (€ 571,376) | 0.02 | £9,256 (€ 11,288) | $44,138 | Yes | Sponsor funded |
| £113,075 (€ 137,896) | 4.66 | BMT | £71,146 (€ 86,763) | 4,06 | 10 years | 3.5% | £70,537 (€ 86,021) | 0.60 | £41,929 (€ 51,133) | $44,138 | No | ||||
| Intrajejunal Levodopa Infusion | |||||||||||||||
| Kristiansen et al., 2009 [18] | Sweden | CEA | SEK 562,000 | 1.48 | BMT | SEK 172,000 | 1.42 | 2 years | 3% | 0.06 | SEK 390,000 | SEK 6,100,000 (€ 665,213) | $40,187 | No | Sponsor funded |
| Lowin et al., 2011 [22] | UK | CEA | £201,192 | 1.88 | BMT | £161,548 | 0.78 | Lifetime | NS | 1.10 | £39,644 | £36,024(€ 41,407) | $37,146 | No | Sponsor funded |
| Kamusheva et al., 2013 [16] | Bulgaria | CEA | BGN 5,655.91 | 57.42(UPDRS) | BMT | BGN 143.49 | 22.67 (UPDRS) | NS | NS | 34.75 (UPDRS) | BGN 1903.56 | BGN 158.63 (€ 81.45) per point UPDRS | $16,582 | Yes | Sponsor funded |
| Lundqvist et al., 2014 [23] | Norway | CEA | NOK 890,920 | 0.68 | BMT | NOK 419,160 | 0.63 | 1 year | NS | 0.05 | NOK 471,760 | NOK 9,200,000(€ 1,180,000) | $65,986 | No | Not sponsor funded |
| Walter & Odin, 2015 [24] | UK | CEA | £130,011 | 3.06 | BMT | £76,793 | 2.62 | 3 years | 3.5% | 0.44 | £53,218 | £120,950(€ 165,685) | $42,522 | No | Sponsor funded |
| Germany | CEA | € 175,004 | 3.18 | BMT | € 90,012 | 2.73 | 3 years | 3% | 0.45 | € 84,989 | € 188,864 | $47,684 | No | ||
| Vivancos-Matellano et al., 2016 [25] *review | Spain | CEA | € 234.643 | 3.12 | CSAI | € 110,348 | 2.89 | 5 years | 3.5% | 0.23 | € 124,295 | € 75,206 | $37,310 | No | Not sponsor funded |
| DBS | € 89,477 | 2.80 | 0.32 | € 146,166 | $37,310 | No | |||||||||
| Lowin et al., 2017 [21] | UK | CEA | € 537,687 | 4.37 | BMT | € 514,037 | 3.49 | Lifetime | NS | 0.88 | € 23,650 | € 26,944 | $45,998 | Yes | Sponsor funded |
| Kalabina et al., 2019 [26] | UK | CEA | £433,154 | 4.56 | BMT | £367,653 | 3.30 | 20 years | NS | 1.26 | £65,501 | £52,110 (€ 59,216) | $48,092 | No | Sponsor funded |
| Continuous subcutaneous apomorphine infusion | |||||||||||||||
| Walter & Odin, 2015 [24] | UK | CEA | £78,251 | 2.85 | BMT | £76,793 | 2.62 | 3 years | 3.5% | 0.23 | £1,458 | £6,440 (€ 8,822) | $42,522 | Yes | Sponsor funded |
| Germany | CEA | € 104,500 | 2.92 | BMT | € 90,012 | 2.73 | 3 years | 3% | 0.19 | € 14,488 | € 74,696 | $47,684 | No | ||
| Vivancos-Matellano et al., 2016 [25] * review | Spain | CEA | € 110,348 | 2.89 | IJLI | € 234,643 | 3.12 | 5 years | 3.5% | –0.23 | –€ 124,295 | € 38,249 | $37,310 | No | Not sponsor funded |
| DBS | € 89,477 | 2.80 | 0.09 | € 20,871 | $37,310 | No | |||||||||
BMT, best medical treatment; CEA, cost-effectiveness analysis; CSAI, continuous subcutaneous apomorphine infusion; CUA, cost-utility analysis; DBS, deep brain stimulation; GPi, globus pallidus internus; ICUR, incremental cost-effectiveness ratio; IJLI, Intrajejunal Levodopa Infusion; NS, not specified; QALY, quality adjusted life years; SEK, Swedish kroner; NOK, Norwegian kroner; BGN, Bulgarian lev. * Cost-effective is defined as whether or not the costs per QALY were below the GDP of the country in the year the study was performed.