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Introduction <p>Parkinson’s disease is the second most common neurodegenerative disorder. In advanced Parkinson’s disease, subcutaneous (SC) infusion therapies represent minimally invasive and reversible treatment options. In the United Kingdom (UK), licensed SC infusion therapies include apomorphine and foslevodopa–foscarbidopa; both represent effective and generally well-tolerated therapies, although uncertainties regarding their relative efficacy, safety and costs remain.</p> Methods <p>The relative efficacy and safety of apomorphine and foslevodopa–foscarbidopa was assessed via Bucher indirect treatment comparison (ITC) of TOLEDO (NCT02006121) and M15-736 (NCT04380142) data, with findings used to support a cost-minimisation analysis (CMM). Thirteen outcomes were evaluated. Efficacy and safety outcomes were measured as mean differences and risk differences, respectively. The CMM, conducted from a UK healthcare payer perspective, considered treatment acquisition and concomitant therapy costs over a 6.34-year horizon (obtained from a published observational study).</p> Results <p>Bucher ITC results provided evidence for a comparable efficacy for apomorphine and foslevodopa–foscarbidopa in advanced Parkinson’s disease. ITCs also indicated comparable safety, although a trend in favour of apomorphine was identified for hallucinations and most infusion&#xa0;site reactions assessed. The CMM demonstrated a clear per-patient cost benefit for apomorphine versus foslevodopa–foscarbidopa (£120,173.70), primarily driven by lower drug acquisition costs.</p> Conclusion <p>The main difference between UK licensed SC infusion therapies for advanced Parkinson’s disease relates to cost as opposed to clinical outcome, with some evidence for improved tolerability of apomorphine. This supports the continued use of apomorphine as first-line SC infusion treatment for advanced Parkinson’s disease in UK clinical practice.</p>

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Licensed Subcutaneous Infusion Therapies in Advanced Parkinson’s Disease: An Indirect Treatment Comparison and Cost-Minimisation Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月8日

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  • Marc Vérin,
  • Ángel Sesar,
  • Bharat Amlani,
  • Niall Smith,
  • Konstantinos Kipentzoglou,
  • Stephen Montgomery,
  • Alice Reading,
  • Andrei Karlsson,
  • Anna Willis,
  • Andrew J. Lees

摘要

Introduction

Parkinson’s disease is the second most common neurodegenerative disorder. In advanced Parkinson’s disease, subcutaneous (SC) infusion therapies represent minimally invasive and reversible treatment options. In the United Kingdom (UK), licensed SC infusion therapies include apomorphine and foslevodopa–foscarbidopa; both represent effective and generally well-tolerated therapies, although uncertainties regarding their relative efficacy, safety and costs remain.

Methods

The relative efficacy and safety of apomorphine and foslevodopa–foscarbidopa was assessed via Bucher indirect treatment comparison (ITC) of TOLEDO (NCT02006121) and M15-736 (NCT04380142) data, with findings used to support a cost-minimisation analysis (CMM). Thirteen outcomes were evaluated. Efficacy and safety outcomes were measured as mean differences and risk differences, respectively. The CMM, conducted from a UK healthcare payer perspective, considered treatment acquisition and concomitant therapy costs over a 6.34-year horizon (obtained from a published observational study).

Results

Bucher ITC results provided evidence for a comparable efficacy for apomorphine and foslevodopa–foscarbidopa in advanced Parkinson’s disease. ITCs also indicated comparable safety, although a trend in favour of apomorphine was identified for hallucinations and most infusion site reactions assessed. The CMM demonstrated a clear per-patient cost benefit for apomorphine versus foslevodopa–foscarbidopa (£120,173.70), primarily driven by lower drug acquisition costs.

Conclusion

The main difference between UK licensed SC infusion therapies for advanced Parkinson’s disease relates to cost as opposed to clinical outcome, with some evidence for improved tolerability of apomorphine. This supports the continued use of apomorphine as first-line SC infusion treatment for advanced Parkinson’s disease in UK clinical practice.