stalevo and Parkinson-Disease

The results of the large-scale study STRIDE-PD of patients with Parkinson's disease (PD) are presented. The aim of the study was to verify whether a combination of levodopa with DOPA decarboxylase and catechol-O-methyltransferase inhibitors (stalevo) could delay the development of dyskinesia compared to the standard two-component drug due to the more stable concentration levodopa in the blood that provided the persistent stimulation of dopamine receptors in the striatum. The results of the study allowed to discuss the issues related to PD treatment, in particular, the dose of levodopa that should not be exceeded to reduce the low risk of fluctuations and dyskinesia, and the necessity of maintaining equivalent doses of levodopa in the combination of antiparkinsonian drugs.

Topics: Antiparkinson Agents; Carbidopa; Catechols; Corpus Striatum; Drug Combinations; Drug Therapy, Combination; Dyskinesias; Humans; Levodopa; Parkinson Disease; Treatment Outcome

Levodopa is the main pharmacologic treatment for Parkinson's disease. However, the long-term administration of levodopa is associated with the development of motor complications which can seriously compromise patient function. Increasing evidence indicates that such problems are related to abnormal pulsatile stimulation of striatal dopamine receptors and that treatments providing more continuous stimulation reduce the risk of motor complications. It is possible that administering levodopa with a reversible catechol-O-methyl transferase inhibitor at frequent intervals might reduce the risk of these complications. Stalevo (Orion) combines levodopa, the dopa-decarboxylase inhibitor carbidopa and the catechol-O-methyl transferase inhibitor entacapone in a single tablet. This review provides an overview of the initial clinical experience gained with Stalevo during clinical trials, including several case studies.

Topics: Antiparkinson Agents; Carbidopa; Catechols; Drug Combinations; Drug Therapy, Combination; Humans; Levodopa; Nitriles; Parkinson Disease

To assess the efficacy and tolerability of the three component drug stalevo in the treatment of patients with Parkinson's disease (PD).. We analyzed the experience of using the antiparkinsonian drug stalevo (levodopa/carbidopa/entacapone) in the treatment of acute stages of PD and elderly patients with restricted possibilities of using other antiparkinsonian drugs. The study included 47 patients. A clinical example is presented. RESULTS AND СONCLUSION: Stalevo increased motor and daily activities, reduced the severity of basic symptoms of PD and improved quality of life of the patients.

Topics: Aged; Antiparkinson Agents; Carbidopa; Catechols; Drug Combinations; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease

Seventy-three patients with Parkinson's disease were enrolled. Patients were stratified into 2 groups by the presence (53 patients) or absence (20 patients) of nocturnal symptoms. A control group included 10 healthy people. The most frequent were the following symptoms: nocturia (71.8%), affective disorders (52.4%), akinesia (41.7%) and crampi (30.15%). These symptoms were more pronounced in akinetic/rigid form, greater severity and higher rate of progression of the disease. The positive therapeutic effect of stalevo on the above mentioned disorders was shown.

Topics: Carbidopa; Catechols; Drug Combinations; Dyskinesias; Humans; Levodopa; Muscle Cramp; Nocturia; Parkinson Disease; Restless Legs Syndrome

Nocturnal symptoms are integral part of the general clinical picture of Parkinson's disease (PD). They are subdivided into non-motor and motor symptoms, the latter included night akinesia, crampi, night akathisia, dystonia, restless leg syndrome (RLS), periodic movements of limbs (PML) and psychomotor agitation during sleep. We have studied 53 patients with PD and evaluated the frequency of these disturbances as follows: night akinesia (42.7%), crampi (31.1%), night akathisia (7.8%), RLS (5.8%), PML (3.8%). The symptoms were treated with the three-component drug stalevo in a single dose in the evening during 3 months. The dose was equivalent to that of levodopa prescribed to the patient earlier in the composition of a two-component drug. The significant reduction of nocturnal motor symptoms with the respective decrease in the frequency of emotional disorders, the improvement of daily activities and quality of life of patients were seen after the treatment.

Topics: Aged; Antiparkinson Agents; Carbidopa; Catechols; Dopamine Agents; Drug Combinations; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Sleep Disorders, Intrinsic

Accumulating data on experience of long therapy with levodopa revealed the pathomorphosis of clinical presentations of Parkinson's disease during its progression, in particular, described, the occurrence of motor fluctuations and levodopa-induced dyskinesias. In later stages of the illness, these disturbances attracted special attention of both the patient, and the attending, worsening quality of a life of patients. The article describes the main issues of the pathogenesis of this type of disorders and the currently available strategies for its treatment. We present our own experience of treatment motor fluctuations by means of the combined three-component medical product stalevo containing levodopa, carbidopa and entacapone.

Topics: Aged; Carbidopa; Catechols; Drug Combinations; Dyskinesia, Drug-Induced; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease

The most effective symptomatic treatment for Parkinson's disease (PD) is levodopa/dopa decarboxylase (DDC)-inhibitor or conventional levodopa. However, after a few years of treatment, motor complications may develop, such as <> and dyskinesias. Symptoms of <> can be both motor symptoms, e.g. tremor and bradykinesia, as well as non-motor symptoms (pain, mood changes and anxiety). The development of these complications may affect the patients quality of life (QOL). To investigate the efficacy and safety direct switch from conventional levodopa to stalevo(levodopa/carbidopa/entacapone) in PD patients with fluctuations and dyskinesias.. Thirty four patients with PD were recruited in the study. The mean age (+/-SD) of the patients was 64,5+/-8,3 years, the mean duration of PD (+/-SD) was 5,9+/-3,1 years, the mean H&Y was 2,5+/-0,5. All patients experienced fluctuations and six had dyskinesias (one patient had biphasic dyskinesias with painful dystonia). The mean baseline levodopa dose was 785,8+/-150,2 mg per day taking in three to six doses. Assessments were performed before, end of 1, 4 and 12 weeks of treatment period and consisted of Hoen/Yahr stages (H&Y), II and III parts of the Unified Parkinson's Disease Rating Scale (UPDRS), patients diaries with registration <> periods, scale EQ-5D, WOQ-9. While switching from conventional levodopa to stalevo taking single levodopa doses were equivalent or less. Maximum allowed doses of stalevo were four times per day.. Direct switch to stalevo results in improvement of motor and non-motor symptoms (pain and anxiety) in fluctuating patients and significant prolongation of <> periods (p<0.01). We observed dramatic improvement biphasic dyskinesias with painful dystonia and reducing severity of dyskinesias in others patients. Improvement was seen in QOL by scale EQ-5D from 10,7+/-1,9 to 8,6+/-2,1 points (p<0,05). Conclusions. Switching from conventional levodopa to stalevo is efficacy and safety and can significantly improve QOL PD patients with fluctuations and dyskinesias.

Topics: Aged; Antiparkinson Agents; Carbidopa; Catechols; Dose-Response Relationship, Drug; Drug Combinations; Female; Follow-Up Studies; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Quality of Life; Treatment Outcome

An open randomized study of pharmacoeconomic efficacy of stalevo in patients with Parkinson's disease with motor fluctuations was conducted. The results of the study revealed that the drug substantially reduced motor deficit, increased the "on"-period, decreased the duration and severity of the "off" period, improved the daily activity and quality of life of patients compared to standard therapy with an additional dosage of levodopa/DDC inhibitor. Despite the increase in cost, the use of stalevo in the treatment of Parkinson's disease with motor fluctuations is cost-effective in long-term (already after two years) management of patients.

Topics: Antiparkinson Agents; Carbidopa; Catechols; Cost-Benefit Analysis; Drug Combinations; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Psychomotor Disorders; Severity of Illness Index

Despite the significant symptomatic effects of levodopa, stable 24-h treatment responses are in the vast majority of patients replaced 2-3 years from the start of treatment by oscillations in motor symptoms (fluctuation, dyskinesia), amelioration of which requires addition of constant (physiological) stimulation of postsynaptic dopamine receptors. To some extent this is provided by Stalevo, which contains levodopa and two enzyme inhibitors: the DDC inhibitor carbidopa and the COMT inhibitor entacapone. The results obtained in the present study demonstrated the advantages of Stalevo over traditional agents in patients with the "wearing off" and "on-off" phenomena.

Topics: Activities of Daily Living; Aged; Antiparkinson Agents; Carbidopa; Catechols; Drug Combinations; Dyskinesias; Female; Humans; Levodopa; Male; Middle Aged; Motor Activity; Outpatients; Parkinson Disease; Severity of Illness Index; Time Factors; Treatment Outcome

The addition of entacapone to levodopa-carbidopa (LC) or the switch from LC to a tablet containing levodopa-carbidopa-entacapone (LCE) improves the wearing-off phenomenon, increases the 'on' time and decreases the 'off' time, but the appearance or exacerbation of dyskinesias is the more frequent side-effect. Thus, a reduction of the total levodopa dosage would be recommended. However, this could result in a lack of efficacy against the wearing-off. We report on the results of a clinical trial conducted to determine the best way in terms of efficacy, tolerability and safety of switching from LC to LCE in patients with Parkinson's disease (PD) and end of dose wearing-off. 39 patients with PD and wearing-off without or with mild dyskinesias were randomly assigned to either a group receiving the same LC dosage or to a group in which the total LC amount was reduced by 15-25%. Four weeks after the change, both groups showed an increase in daily 'on' time and a reduction in the daily time spent in 'off'. Two patients in each group experienced an increase in basal dyskinesias. No differences in clinical assessment between groups were found. Tolerance was excellent. This study suggests that switching from LC to LCE in patients with mild-to-moderate wearing-off can be done safely with or without reducing the total LD amount, but in the clinical setting it would be more practical to keep the dosage of LC unchanged unless severe dyskinesias are present.

Topics: Aged; Antiparkinson Agents; Carbidopa; Catechols; Drug Combinations; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease

Despite significant symptomatic effect of levodopa, in most patients the stable 24 hour's effect changed for alterations of movement symptoms (fluctuations, dyskinesia) after 2-3 years of the therapy. These complications may be reduced due to the constant (physiologic) stimulation of post-synaptic dopamine receptors that, to a certain degree, provides the drug stalevo, which contains levodopa and 2 enzyme inhibitors, dopa decarboxylase (carbidopa) and catechol-O-methyltransferase (entacapone). The results of the study demonstrated beneficial effects of stalevo as compared to traditional therapy in patients with "wearing off" and "on-off" phenomena.

Topics: Activities of Daily Living; Aged; Ambulatory Care Facilities; Carbidopa; Catechols; Dose-Response Relationship, Drug; Drug Combinations; Female; Follow-Up Studies; Humans; Levodopa; Male; Outpatients; Parkinson Disease; Severity of Illness Index; Time Factors; Treatment Outcome

This study investigated the ease with which 52 Parkinson's disease patients already receiving adjunct entacapone to traditional levodopa were switched to Stalevo (levodopa/carbidopa/entacapone).. The switch to Stalevo was straightforward for most patients taking standard-release levodopa with 86% of these patients being able to replace their entire regimen without having to change the amount of levodopa taken. The majority of patients (54%, P = 0.162) preferred Stalevo; 31% preferred their prior treatment regimen; 15% had no preference. Patients found Stalevo more simple to dose (94%), more convenient to use (84%), easier to handle (84%), easier to remember (67%) and easier to swallow (59%), compared with their previous medication.. Stalevo was well tolerated, with a low incidence of adverse events. The study shows that Stalevo is an effective, preferred and well-tolerated means of delivering levodopa/carbidopa/entacapone in one easy-to-use tablet.

Topics: Adult; Aged; Antiparkinson Agents; Aromatic Amino Acid Decarboxylase Inhibitors; Carbidopa; Catechols; Cross-Over Studies; Drug Combinations; Female; Humans; Levodopa; Male; Middle Aged; Nitriles; Parkinson Disease; Patient Satisfaction; Treatment Outcome

Based on literature data on the usage of Dopa medications in the treatment of Parkinson's disease (PD), a characteristic of a new complex drug stalevo, which includes levodopa, carbidopa and entacapon (catechol-O-methyltransferase inhibitor), is presented. The authors studied 15 patients with PD, aged 55.6+/-8.7 years, illness duration 7.7+/-3.1 years, who received stalevo during 6 weeks and revealed that stalevo reduced significantly the intensity of main PD symptoms, especially hypotension and rigidity as well as motor fluctuations, and improved general movement and daily activity of patients thus ameliorating their quality of life. The drug is well-tolerable.

Topics: Antiparkinson Agents; Carbidopa; Catechols; Drug Combinations; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Severity of Illness Index

To evaluate the tolerability, safety and efficacy of Stalevo (carbidopa, levodopa and entacapone) in Parkinson's disease (PD).. Levodopa provides the most effective symptom control for the treatment of Parkinson's disease (PD). However, its long-term use is limited by the development of motor complications such as wearing-off. Catechol-O-methyltransferase (COMT) inhibitors such as entacapone extend the plasma half-life of levodopa and reduce 'off' time. Stalevo is a new levodopa product that combines carbidopa, levodopa and entacapone in one tablet. Clinical studies have not been reported with this compound.. An open-label, multi-center US trial evaluated 169 consecutive PD patients experiencing end-of-dose wearing-off, with (n = 39) and without (n = 130) mild dyskinesia. Patients were switched from immediate-release carbidopa/levodopa to Stalevo and were treated for four weeks. Assessments included tolerability measures, adverse events profile, the disease-specific quality of life instrument PDQ-39, UPDRS parts II, III, and question 39 and investigator and patient global clinical assessments.. 14 subjects (8%) discontinued treatment with Stalevo, of which 12 (7%) were due to adverse events. 11/130 (8.5%) subjects developed new onset dyskinesia and 17/39 (43.6%) of patients with existing dyskinesia reported a worsening in their dyskinesia. However, this was managed by a change in dose in 21.4% of patients and in another 10.7% dyskinesias resolved without any need for dose adjustment. Other side effects were infrequent and mild, the most common being nausea (12.4%) dizziness (6.5%) and somnolence (6.5%). Stalevo treatment resulted in significant improvements in PDQ-39 and UPDRS (II + III) scores (p < 0.001). Assessment of 'off' time demonstrated a reduction in off time in 32% of patients, compared with an increase in 7% of patients. Improvements were noted by both investigator (68.1%) and patient (68.6%) assessments.. Switching PD patients experiencing wearing-off from carbidopa/levodopa therapy to Stalevo was safe, well tolerated and resulted in clinical improvement.

Topics: Adult; Aged; Carbidopa; Catechols; Drug Combinations; Drug Tolerance; Female; Humans; Levodopa; Male; Middle Aged; Nausea; Parkinson Disease

The aim of this study was to evaluate the efficacy of the new optimised levodopa, Stalevo (levodopa, carbidopa and entacapone) in patients with Parkinson's disease experiencing end-of-dose wearing-off. Treatment with Stalevo was compared to treatment with traditional immediate-release levodopa and dopa-decarboxylase inhibitor (DDCI) formulations along with adjunct entacapone (Comtess/Comtan). A European, open, parallel-group, active treatment-controlled phase IIIb study evaluating 176 patients randomised to switch from their current regimen of levodopa/DDCI to either an equivalent dose of Stalevo or levodopa/DDCI plus entacapone. After 6 weeks, treatments were assessed using the Clinical Global Impression of Change, the Unified Parkinson's Disease Rating Scale and a Motor Fluctuations Questionnaire. Over 70% of patients in both the Stalevo and adjunct entacapone arms felt that they were clinically improved and over 80% experienced a reduction in fluctuations. Although there was no significant difference between Stalevo and levodopa/DDCI plus entacapone with regard to motor improvement and side effects, 81% of patients stated that they preferred treatment with Stalevo compared with taking two separate tablets (i.e. levodopa/DDCI and entacapone). Stalevo was well tolerated and safe when substituted for levodopa DDCI preparations.

Topics: Aged; Antiparkinson Agents; Carbidopa; Catechols; Disability Evaluation; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Enzyme Inhibitors; Female; Follow-Up Studies; Humans; Levodopa; Male; Middle Aged; Motor Activity; Nitriles; Pain Measurement; Parkinson Disease; Quality of Life; Severity of Illness Index; Single-Blind Method; Surveys and Questionnaires; Treatment Outcome

Impulse control disorders (ICDs) are a known side effect of dopamine replacement therapy in patients with Parkinson's disease (PD). They can have devastating consequences for patients and their families.

Topics: Adult; Amantadine; Antiparkinson Agents; Benzothiazoles; Carbidopa; Catechols; Disruptive, Impulse Control, and Conduct Disorders; Drug Combinations; Female; Humans; Indans; Indoles; Levodopa; Male; Middle Aged; Neuroprotective Agents; Parkinson Disease; Pramipexole; Selegiline

Levodopa remains a 'gold standard' for the treatment of patients with Parkinson's disease (PD), but its chronic use is accompanied by fluctuations of symptoms and dyskinesias related to unfavorable pharmacokinetics of levodopa and progressing loss of the nigrostriatal neurons. Prescribing inhibitors of catechol-O-methyl-transferase (enzyme of dopamine metabolism), entacapone or tolcapone, is a perspective approach to the correction of the above-mentioned complications. We followed up 402 patients with PD who received long-term therapy with a combined preparation Stalevo (levodopa/carbidopa/entacapone) for 2-5 years (2.9 ± 0.9 years). The high (92.8%) compliancy and good tolerance of the drug in patients with PD was shown. Stalevo leads to the stabilization of the response to levodopa, improvement of patients' functional capacities, increase in their everyday activity, and improvement of quality of life. Stalevo may be regarded as a preparation of choice in the treatment of motor complications in elderly patients, correction of night symptoms of PD and in a number of other clinical situations arising in hospital and outpatient practice.

Topics: Adult; Aged; Aged, 80 and over; Carbidopa; Catechols; Dopamine Agonists; Drug Administration Schedule; Drug Combinations; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Treatment Outcome

All patients with Parkinson's disease (PD) with motor fluctuations due to long-term levodopa therapy have at least one non-motor fluctuation symptom. Fluctuations of non-motor symptoms associated with levodopa action phases may influence patient's quality of life more negatively than motor fluctuations. However issues related to treatment of non-motor fluctuations have not been specially studied so far. We have carried out an open observational study of an effect of a combined formulation of levodopa, carbidopa and entacapone (stalevo) on non-motor fluctuations. Forty patients with PD were included in the study. A self-reported daily diary has been administered for assessment of motor and 12 most frequent non-motor symptoms (e.g., sweating, bladder dysfunction, short-breath, pain, fatigue, dysphoria, irritability). The principle of equivalence of levodopa daily dose was used while switching patients from a bicomponent levodopa formulation to stalevo. The condition of patients was evaluated at baseline and after 3 months of treatment. The duration of off-period has decreased on the average by 1,8 h a day. The reduction of autonomic and neuropsychiatric symptoms (sweating, heat and cold sensations, bladder dysfunction, short-breath, slowness of thinking) was found. The decrease in non-motor fluctuation severity was correlated with the reduction of off-period duration. Thus, stalevo exerts the effect both on motor fluctuations and on a wide range of fluctuating non-motor symptoms.

Topics: Adult; Aged; Carbidopa; Catechols; Drug Combinations; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Treatment Outcome

In Stalevo tablets, used in the therapy of patients with Parkinson's disease, levodopa is combined with decarboxylase inhibitors and COMT inhibitors to provide a more steady plasma concentration of levodopa. Previously several study has shown, that the better pharmacokinetic profile decreases the fluctuation of motor and non-motor symptoms. Better control of symptoms improves quality of life. Ideal blood levels of levodopa however can only be achieved by multiple daily dosing. This may be uncomfortable, may decrease compliance, thereby influence quality of life. To evaluate this, an observational follow-up study was undertaken in Hungary in 2007, among patients who were given Stalevo - independently of this study - because of signs of decrease in the duration of drug effect (wearing off). Patients got Stalevo in three, four or five daily divided dosages, the results were assesed after three months. The study included 223 patients (ITT population), of whom 208 (PP population) responded regarding quality of life on both visits. Statistical analysis of the results showed that treatment significantly decreased symptoms of wearing off (wearing off card with 19 items) and improved quality of life (EQ-5D and VAS quality of life scale) regardless of the frequency of dosing.

Topics: Aged; Antiparkinson Agents; Carbidopa; Catechols; Drug Administration Schedule; Drug Combinations; Female; Humans; Hungary; Levodopa; Male; Middle Aged; Observation; Parkinson Disease; Quality of Life; Treatment Outcome

The triple combination of levodopa, DDCI and entacapone (Stalevo) is used to treat motor complication in patients with Parkinson's disease. In this study we summarized the clinical data of our patients treated with Stalevo for the longest period. We can concluded, that after switching to Stalevo due to wearing off, the average levodopa doses were lower then before and the motor complications were milder. After 3 years of Stalevo therapy the levodopa doses were increased but still did not reach the average doses before introducing Stalevo. After switching the patients' general well-being was improved as indicated by the visual analogue scale. In summary, the Stalevo treatment is safe and effective for long run and improves the patients' quality of life.

Topics: Aged; Antiparkinson Agents; Carbidopa; Catechols; Drug Combinations; Drug Resistance; Dyskinesia, Drug-Induced; Female; Humans; Levodopa; Male; Middle Aged; Pain Measurement; Parkinson Disease; Quality of Life; Severity of Illness Index; Time Factors; Treatment Outcome

The triple combination of levodopa, DDCI and entacapone (Stalevo) is used to treat motor complication in Parkinsonian patients with fluctuation. An observational investigation has been conducted in Hungary to study the effects of Stalevo on the "wearing off" phenomenon and on the quality of life in patients, who are to be treated with. The introduction of Stalevo to the treatment resulted in no changes in the number of patients taking selegiline, amantadine and dopamine agonists, while the number of patients taking anticholinergic drugs were slightly increased. This treatment significantly decreased the average Hoehn-Yahr stadium, as well as the non-motor symptoms, without any remarkable side effect. Stalevo also improved the quality of life, detected by the EQ-5D questionnaire and the visual analogue scale.

Topics: Adult; Aged; Amantadine; Antiparkinson Agents; Carbidopa; Catechols; Cholinergic Antagonists; Dopamine Agonists; Drug Combinations; Female; Humans; Hungary; Levodopa; Male; Middle Aged; Parkinson Disease; Quality of Life; Selegiline; Surveys and Questionnaires; Time Factors; Treatment Outcome

A Markov model was developed to evaluate the cost-effectiveness of levodopa/carbidopa/entacapone (LCE;Stalevo), in the treatment of patients with Parkinson's disease (PD) and end-of-dose motor fluctuations (wearing-off). LCE, with or without other antiparkinsonian medications, was compared to UK standard care, comprising traditional levodopa/ dopa-decarboxylase inhibitor (DDCI) with other antiparkinsonian medications (e.g. selegiline or dopamine agonists) added as needed. The costs and outcomes of both treatments were projected over a period of 10 years from the perspective (a) of society as a whole and (b) of the UK National Health Service (NHS). Sensitivity analyses, including second-order Monte Carlo simulations, were performed to assess the confidence level of the primary results.. Treatment with LCE produced an average gain of +1.04 quality-adjusted life-years (QALYs) per patient (2.57 vs. 1.53) in the base-case analysis (discount rate 3.5%). This gain was accompanied by a reduction in the total 10-year direct cost of care to society of 10198 pounds per patient ( approximately E14800). From the societal perspective, therefore, LCE was dominant, producing better clinical outcomes with lower costs. This dominance was reiterated in all sensitivity analyses of society-focused analysis, including a shortening of the time-frame to 5 years. Although treatment with LCE resulted in an increase in direct costs per patient of 3239 pounds (25756 pounds versus 22517 pounds) to the NHS over the 10-year period analysed, the incremental cost-effectiveness ratio (ICER) of LCE was only 3105 pounds per QALY gained (approximately E4500). All ICERs to the NHS remained below 3800 pounds per QALY gained in univariate sensitivity analyses applying different discount rates. When a shorter, 5-year, time-horizon was analysed, the NHS-related ICER for LCE was 6526 pounds per QALY gained. All these ICERs are within the range usually considered to indicate acceptable or highly acceptable cost effectiveness (defined as < 30000 pounds per QALY gained). The results of the Monte Carlo simulations indicated that the likelihood of LCE being either 'dominant' or more effective at an 'acceptable cost' from either the societal or the NHS perspective was high, exceeding 96% in the base-case sensitivity analysis, and was 93% even when all the uncertainties associated with the model were taken into consideration simultaneously. In particular, compared to standard care, the probability that LCE would provide better outcomes at a lower cost to society as a whole was 77% in the base-case sensitivity analysis and 72% in the scenario involving the highest degree of uncertainty.. In the UK the use of LCE to treat PD patients with wearing-off is beneficial to individual patients and likely to offer money savings to society as a whole, compared with UK standard therapy. The added cost of the medication itself is exceeded by the savings made in other direct costs of PD, mainly those relating to social care or PD-related private expenditures.

Topics: Adolescent; Adult; Aged; Antiparkinson Agents; Carbidopa; Catechols; Child; Cost-Benefit Analysis; Drug Combinations; Drug Costs; Female; Humans; Levodopa; Male; Markov Chains; Middle Aged; Parkinson Disease; United Kingdom

Topics: Carbidopa; Catechols; Diarrhea; Dose-Response Relationship, Drug; Drug Combinations; Humans; Levodopa; Nausea; Nitriles; Parkinson Disease