OBJECTIVES:

In August, 2017, the FDA approved ADS-5102 (amantadine) extended-release capsules (GOCOVRI^TM, Adamas Pharmaceuticals, Inc.) as the first medication for the treatment of dyskinesia in patients with Parkinson’s disease (PD) receiving levodopa-based therapy. This economic evaluation projects the likely cost-effectiveness of this new therapy compared to current best supportive care.

METHODS:

This economic evaluation was conducted using a cost-utility model with a 5-year base-case patient time horizon from a European (German) payer perspective. The primary economic endpoint was the incremental cost per quality-adjusted life year (QALY) gained. The key clinical parameters were PD home diary-based measures from the EASE LID trials of the average daily reduction from baseline in OFF-time and ON-time with dyskinesias. Natural disease progression was modeled on- and off-treatment. Each outcome was associated with utility values for patient quality of life, which were summed to QALYs. The cost of ADS-5102 was included along with a literature-based standard cost of care for PD patients (assumed to decrease for treated patients). Discounted (at 3%) total costs (in €2017) were summed over the horizon. No adverse events or mortality impacts were modeled.

RESULTS:

In the base case, the projected incremental cost-utility ratio was €24,472, ranging from €12,001 to €36,942 over a 5-year horizon, varying by cost-offset size. The results are also sensitive to key assumptions about: (1) the utilities of OFF-time, ON-time, and ON-time with dyskinesias; and (2) rate of disease progression with and without treatment. Deterministic and probabilistic sensitivity results will be presented.

CONCLUSIONS:

From a clinical perspective, ADS-5102 is a promising new treatment for PD patients with dyskinesia. From an economic perspective, the projected cost-utility ratio appears to be acceptable by commonly-cited thresholds of societal willingness to pay. More data collection on PD patient utilities and disease progression are needed to validate critical assumptions of this model