OBJECTIVES: Parkinson Disease (PD) is the second commonest cause of neurological disability and affected approximately 5.2 million men and women worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option of 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: We developed a multicounty 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. Complications are different for the alternatives (e.g. pump problems in case of LCIG, temporary/permanent complications in case of DBS). We include moderate and severe adverse-events and death. Monte-Carlo-simulation accounted for uncertainty. The model includes 25 health-states. Probabilities were derived from RCT and open-label studies; direct costs (2012) from published sources from the payer’s perspective (NHS and German health care systems). QALYs, life-years (LYs) and costs were projected over a life-time horizon and discounted according the national guidelines. RESULTS: UK life-time costs associated with CSAI amounts to 70,258 £ and generates 2.85 QALYs and 6.28 LYs (106,530 €, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are 117,121 £, achieves 3.06 QALYs and 6.93 LYs (178,405 €, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was 223,052 £ (281,089 €). Costs for DBS are 88,361.61 £, associated with 2.75 QALYs and 6.38 LYs (121,988 €, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are 68,082.92 £; 2.62 QALYs and 5.76 LYs were reached (91,588 €, 2.7 3QALYs and 6 LYs for Germany).  CONCLUSIONS: CSAI is a cost-effective treatment alternative, reducing OFF-time and improving quality-of-life and is associated with a cost-advantage.