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.