Cost-Effectiveness Analysis of Inhaled Levodopa for Managing OFF Episodes in Patients With Parkinson’s Disease
Author(s)
Ubong Silas, MSc1, Julie Brown, MSc2, Daniel Evans, MSc3, Leandro Guerra Primo, MSc4, Stefano Perni, PhD3.
1Merz Therapeutics, Frankfurt, Germany, 2Merz Therapeutics, London, United Kingdom, 3FIECON, a Herspiegel Company, London, United Kingdom, 4FIECON, a Herspiegel Company, Rotterdam, Netherlands.
1Merz Therapeutics, Frankfurt, Germany, 2Merz Therapeutics, London, United Kingdom, 3FIECON, a Herspiegel Company, London, United Kingdom, 4FIECON, a Herspiegel Company, Rotterdam, Netherlands.
OBJECTIVES: Inbrija® (inhaled levodopa) is non-invasive and bypasses the gastrointestinal tract, enabling rapid symptom relief of OFF episodes for patients with Parkinson’s disease (PD) treated with levodopa/carbidopa (LD-CD). This study assesses the cost-effectiveness of inhaled levodopa compared to apomorphine sublingual (APO-SL), apomorphine subcutaneous (APO-SC), dispersible levodopa (LD) and no on-demand treatment (no-ODT) in a UK population.
METHODS: A 12 state Markov model was developed with health states based on one-hour increments of OFF ranging from ON to OFF10+ plus death, based on the model submitted in NICE TA934. Pivotal trial SPAN-PD informed inhaled levodopa clinical efficacy; a network meta-analysis informed APO-SL and APO-SC relative efficacy. The natural history of progression (NH) of PD was assumed equal to that of baseline LD-CD treatment, informing efficacy for no-ODT. There is no statistical difference between LD and baseline LD-CD treatment in latency to ON, resulting in an assumption that efficacy of LD is equal to NH given data limitations. After discontinuing treatment, patients received a basket of subsequent therapies including apomorphine, levodopa-carbidopa intestinal gel and deep brain stimulation.
RESULTS: The base-case results demonstrate inhaled levodopa is associated with 6.648 quality-adjusted life years (QALY), and £153,378 total costs. Inhaled levodopa dominates when compared to dispersible LD and no-ODT. The incremental difference in costs between inhaled levodopa and APO-SC or APO-SL is -£8,592 and -£25,008, respectively. The incremental QALYs between inhaled levodopa and APO-SC or APO-SL are -0.166 and -0.108, respectively. Under the willingness-to-pay (WTP) of £30,000, the net monetary benefit (NMB) to the NHS of incorporating inhaled levodopa would be £3,602 compared to APO-SC, £21,756 compared to APO-SL, £11,655 compared to dispersible LD and £34,128 compared to no-ODT.
CONCLUSIONS: The cost-effectiveness analysis results, alongside the NMB, indicate inhaled levodopa could be a cost-saving alternative in the management of OFF episodes in PD patients for the UK population.
METHODS: A 12 state Markov model was developed with health states based on one-hour increments of OFF ranging from ON to OFF10+ plus death, based on the model submitted in NICE TA934. Pivotal trial SPAN-PD informed inhaled levodopa clinical efficacy; a network meta-analysis informed APO-SL and APO-SC relative efficacy. The natural history of progression (NH) of PD was assumed equal to that of baseline LD-CD treatment, informing efficacy for no-ODT. There is no statistical difference between LD and baseline LD-CD treatment in latency to ON, resulting in an assumption that efficacy of LD is equal to NH given data limitations. After discontinuing treatment, patients received a basket of subsequent therapies including apomorphine, levodopa-carbidopa intestinal gel and deep brain stimulation.
RESULTS: The base-case results demonstrate inhaled levodopa is associated with 6.648 quality-adjusted life years (QALY), and £153,378 total costs. Inhaled levodopa dominates when compared to dispersible LD and no-ODT. The incremental difference in costs between inhaled levodopa and APO-SC or APO-SL is -£8,592 and -£25,008, respectively. The incremental QALYs between inhaled levodopa and APO-SC or APO-SL are -0.166 and -0.108, respectively. Under the willingness-to-pay (WTP) of £30,000, the net monetary benefit (NMB) to the NHS of incorporating inhaled levodopa would be £3,602 compared to APO-SC, £21,756 compared to APO-SL, £11,655 compared to dispersible LD and £34,128 compared to no-ODT.
CONCLUSIONS: The cost-effectiveness analysis results, alongside the NMB, indicate inhaled levodopa could be a cost-saving alternative in the management of OFF episodes in PD patients for the UK population.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE205
Topic
Economic Evaluation, Health Technology Assessment
Disease
Neurological Disorders