Objective: To investigate whether the use of Opicapone as an add-on therapy to levodopa-carbidopa intestinal gel (LCIG) infusion in advanced Parkinson’s disease (PD) reduces the LCIG daily dose and potentially the cost of this therapy.

Background: LCIG therapy is associated with high costs of care as described by NICE in the UK [1]. Currently, about 10% of PD patients on LCIG infusion require two cassettes per day [1]. The recently released Opicapone offers an unexplored and potentially powerful way of reducing LCIG daily dose increasing the efficacy of this therapy with attendant cost savings.

Method: In this observational report of clinical pathway at King’s College Hospital, London. Thus far 8 PD patients, who were treated with LCIG infusion and subsequent addition of Opicapone 50mg/day, have been included. Patients were assessed before and after Opicapone introduction and the following data were recorded: demographics, levodopa equivalent daily dose (LEDD), and Parkinson’s KinetiGraph (PKG) bradykinesia and dyskinesia scores. The primary outcome of this study was to assess the reduction of LCIG daily dose and the potential reduction of LCIG-associated costs after the introduction of Opicapone.

Results: After the introduction of Opicapone the median LCIG daily dose was reduced from 1,471.0 to 1,062.5 mg (408.5 mg equating to 20.4 mL). This may lead to a gross cost saving of £15.73 (cost per mL £0.77) per day and £5,744.38 per year [2,3]. After subtracting the cost for Opicapone (£1143.23 per year [4]) this results in potential net savings of £4,601.15 on an annual base. There were no changes in the motor state of patients as assessed by PKG (bradykinesia score p= 0.89, dyskinesia score p=0.69; Wilcoxon Signed-rank test).

Conclusion: The introduction of Opicapone to LCIG infusion resulted in a median 27.8% reduction of LCIG daily dose and a potential cost saving of £4,601.15 per annum per patient and clinically there was no worsening of dyskinesia.  Future use of this combination therapy could be considered from a both clinical and cost saving perspective.

References: 1. Lowin J, Sail K, Baj R, Jalundhwala YJ, Marshall TS, Konwea H, Chaudhuri KR. The cost-effectiveness of levodopa/carbidopa intestinal gel compared to standard care in advanced Parkinson’s disease. J Med Econ. 2017 Nov;20(11):1207-1215. 2. www.mims.co.uk/drugs/central-nervous-system/parkinsons-disease-parkinsonism/duodopa/ 3. Royal Pharmaceutical Society, Duodopa, in British National Formulary 65. 2013, BMJ and Pharmaceutical Press: London, p.315 4. www.nice.org.uk/advice/es9/chapter/estimated-impact-for-the-NHS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/opicapone-and-levodopa-carbidopa-intestinal-gel-infusion-a-cost-saving-analysis-in-the-united-kingdom/