Ann Pharmacother 1998 Sep;32(9):878-83
Pharmacoeconomic analysis of using sinemet CR over standard sinemet in
parkinsonian patients with motor fluctuations.
Hempel AG, Wagner ML, Maaty MA, Sage JI
College of Pharmacy, Rutgers, State University of New Jersey, Piscataway
08854, USA.
[Medline record in process]
OBJECTIVE: To compare the costs of pharmacotherapy in patients with
Parkinson's disease before and after converting from
standard Sinemet to extended-release Sinemet CR.
DESIGN: Investigators retrospectively reviewed records of patients
converting from Sinemet to Sinemet CR for efficacy and total drug costs.
Cost-effectiveness was evaluated retrospectively from
data collected in prospective Sinemet CR efficacy trials.
SETTING: Parkinson's disease clinic at a tertiary care university
teaching hospital.
PATIENTS: 100 patients with motor fluctuations who had undergone an
initial 6-month course of Sinemet
therapy, followed by a 6-month course of Sinemet CR. MAIN OUTCOME
MEASURES: Total cost was measured as the
cost of Sinemet formulations plus the costs of other antiparkinson
medications. Differences in pre- and postconversion costs
were compared by using the paired, two-tailed Student's t-test. A
substudy of 39 patients on the cost-effectiveness of
conversion measured the ratio of daily medication costs to the daily
hours "on" without chorea. RESULTS: While total daily
medication costs after conversion increased by 21%, patients experienced
either a comparable or an improved degree of
disease control with Sinemet CR. Patients who were also taking
selegiline were able to decrease selegiline expense by 20%.
The costs of other adjunctive medications did not differ significantly
after conversion. The cost-effectiveness analysis revealed an
increase in postconversion on time by 2.2 hours (p = 0.0001),
accompanied by a $2.85 decrease in total cost per hour on
without chorea (p = 0.11).
CONCLUSIONS: Although Sinemet CR is more costly, it may be more
cost-effective in patients with motor fluctuations. Some patients may be
able to reduce adjunctive medications.
PMID: 9762373, UI: 98435121
--
Judith Richards, London, Ontario, Canada
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