Objective: To determine the costs of continuous intrajejunal levodopa infusion (CILI) and deep brain stimulation (DBS) for Parkinson’s disease (PD), and to study the cost-effectiveness and cost-utility of CILI relative to DBS.

Background: CILI and DBS are effective therapies for PD. It is not known whether the probable higher costs of CILI compared to DBS are justified by gain in quality of life (QoL) or quality adjusted life years (QALY).

Method: Patients with PD eligible for both therapies were randomly assigned to CILI or DBS in a prospective open label multicenter trial in the Netherlands. Cost-effectiveness and cost-utility analyses from the Dutch societal perspective were performed, comparing CILI with DBS during 12 months. QoL (PDQ-39SI), generic health status (EQ-5D-3L) and resource use were assessed. A prespecified lenient cost-effectiveness threshold of €120,000 per additional QALY was applied. Uncertainty was captured with bootstrapping. Data were analysed in a modified Intention-To-Treat population; i.e., an ITT population only including patients who had started the allocated treatment.

Results: Mean societal costs for one year of treatment with CILI (n=21) were €63,581 (BCa 95% CI: €53,698-€74,768) and for DBS (n=26) €31,453 (BCa 95% CI: €21,063-€43,480). The difference of €32,128 (BCa 95% CI: €14827 to €48470, p=0.001) was statistically significant. The between-group difference in mean change in PDQ-39SI relative to baseline favored DBS (-4.1 points; 95% CI ‑2.9 to 11.0, p=0.25). For QALY, this was -0.005 in favor of DBS (BCa 95% CI: ‑0.082 to 0.071). The higher costs of CILI were not associated with a sufficiently larger increase in QoL or QALY. The price level of CILI-cassettes should drop by 80% in order to become a cost-effective treatment from a societal perspective at the prespecified cost-effectiveness threshold.

Conclusion: In the Netherlands, the significantly higher mean yearly costs of CILI compared to DBS are not justified by a mean yearly gain in PDQ-39SI or QALY. Therefore, CLI is not a cost-efficient treatment for patients with advanced PD who are eligible for both treatments. The clinical outcomes of the INVEST study are provided elsewhere.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/randomized-controlled-trial-comparing-continuous-intrajejunal-levodopa-infusion-and-deep-brain-stimulation-for-parkinsons-disease-cost-effectiveness-and-cost-utility-outcomes-of-the-invest-s/