Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson's disease in the UK and Germany

J Med Econ. 2015 Feb;18(2):155-65. doi: 10.3111/13696998.2014.979937. Epub 2014 Nov 11.


Background: Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting ∼ 5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC).

Methods: A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3-5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider's perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon.

Results: UK lifetime costs associated with CSAI amounts to £78,251.49 and generates 2.85 QALYs and 6.28 LYs (€104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are £130,011.34, achieves 3.06 QALYs and 6.93 LYs (€175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was £244,684.69 (€272,914.58). Costs for DBS are £87,730.22, associated with 2.75 QALYs and 6.38 LYs (€105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are £76,793.49; 2.62 QALYs and 5.76 LYs were reached (€90,011.91, 2.73 QALYs and 6 LYs for Germany).

Conclusions: From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.

Keywords: Advanced Parkinson disease; Apomorphine; Cost-utility-analysis; Germany; UK.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiparkinson Agents / economics*
  • Antiparkinson Agents / therapeutic use*
  • Apomorphine / economics*
  • Apomorphine / therapeutic use*
  • Carbidopa / economics
  • Carbidopa / therapeutic use
  • Cost-Benefit Analysis
  • Deep Brain Stimulation / economics
  • Drug Administration Schedule
  • Gels
  • Germany
  • Humans
  • Injections, Subcutaneous
  • Levodopa / economics
  • Levodopa / therapeutic use
  • Markov Chains
  • Models, Econometric
  • Parkinson Disease / drug therapy*
  • Quality of Life
  • Quality-Adjusted Life Years


  • Antiparkinson Agents
  • Gels
  • Levodopa
  • Carbidopa
  • Apomorphine