Objective: Quantify the value of improvement in functional status (FS) measured as activities of daily living (ADL) limitations, from levodopa-carbidopa intestinal gel (LCIG) use among the advanced Parkinson’s disease (APD) population.

Background: Limitations in ADLs impact quality of life (QoL) and healthcare spending. Advanced treatments like LCIG may create value for APD patients by reducing ADL limitations.

Methods: The 1992-2010 Medicare Current Beneficiary Survey (MCBS) was used to construct a US-representative Parkinson’s disease (PD)-susceptible cohort. APD was defined from the literature and expert input. MCBS was used to estimate how APD affects ADL limitations, mortality, and medical costs in this cohort. These estimates were combined with estimated relationships from The Health Economic Medical Innovation Simulation (THEMIS), a microsimulation model of how health conditions other than (A)PD influence health and medical spending. The resulting model of the APD population was used to simulate the health and cost burden of disability in APD, and the value of quality-adjusted life-years (QALYs) gained from LCIG use relative to standard of care (SoC), optimized oral therapy. Reduced odds of ADL limitations from LCIG were based on clinical trial data (control: optimized oral levodopa-carbidopa IR).

Results: Based on clinical trial data, LCIG compared to SoC lowers the odds of difficulties in walking, dressing, and bathing by 55%, 77% and 69%, respectively. When applied to all APD cases emerging from the PD-susceptible cohort, these reductions generated 26,500 QALYs and $1.9 billion (B) in healthcare cost savings to all payers. Using estimates from the literature that a QALY is worth $200,000, health improvements and cost savings from LCIG treatment generate $7B in value across payers and patients relative to SoC. Disability due to APD imposes total QoL and medical costs of $53B, LCIG lowers these costs by 13%. Cost savings partially derive from 13,696 fewer patient-years spent by LCIG-treated APD patients in nursing homes, contributing to $900 million in reduced Medicaid spending.

Conclusions: FS improvements from LCIG therapy for APD create health benefits and reduce healthcare costs. Future studies could quantify the full benefits of therapy compared with its costs, in addition to the ADLs analyzed here.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/the-social-value-of-improvement-in-activities-of-daily-living-from-levodopa-carbidopa-intestinal-gel-use-among-the-advanced-parkinsons-disease-population/