Pramipexole v. levodopa as initial treatment for Parkinson's disease: a randomized clinical-economic trial

Med Decis Making. Sep-Oct 2004;24(5):472-85. doi: 10.1177/0272989X04268960.


Purpose: To determine the 2-year incremental cost effectiveness of initial pramipexole treatment compared with initial levodopa treatment in patients with 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 dollars (SE = 1,182 dollars) more expensive than levodopa strategy. The incremental cost-effectiveness of pramipexole compared with levodopa was 106,900 dollars/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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Antiparkinson Agents / administration & dosage
  • Antiparkinson Agents / economics*
  • Benzothiazoles
  • Cost of Illness*
  • Cost-Benefit Analysis
  • Drug Tolerance
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Levodopa / economics*
  • Levodopa / pharmacology
  • Levodopa / therapeutic use
  • Male
  • Middle Aged
  • Parkinson Disease / drug therapy*
  • Parkinson Disease / economics*
  • Placebos
  • Pramipexole
  • Quality of Life
  • Quality-Adjusted Life Years
  • Thiazoles / economics*
  • Thiazoles / pharmacology
  • Thiazoles / therapeutic use


  • Antiparkinson Agents
  • Benzothiazoles
  • Placebos
  • Thiazoles
  • Levodopa
  • Pramipexole