Cost-effectiveness analysis of the Parkinson’s KinetiGraph and clinical assessment in the management of Parkinson's Disease

Chaudhuri, K. Ray, Hand, Annette, Obam, Fallon and Belsey, Jonathan (2022) Cost-effectiveness analysis of the Parkinson’s KinetiGraph and clinical assessment in the management of Parkinson's Disease. Journal of Medical Economics, 25 (1). pp. 774-782. ISSN 1369-6998

Preview	Text 13696998.2022.pdf - Published Version Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1MB) | Preview
Preview	Text Cost effectiveness analysis of the Parkinson s KinetiGraph and clinical assessment in the management of Parkinson s Disease.pdf - Accepted Version Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1MB) | Preview

Abstract

Aims: The Parkinson’s KinetiGraph (PKG) is a wrist-worn movement recording system that collates continuous, objective, data during daily activities in people with Parkinson’s disease (PD) providing a report for clinicians. This study explores the cost-effectiveness of adding the PKG to routine PD assessments.

Methods: A de novo Markov model of three health states: uncontrolled, controlled and death compared PKG plus routine assessment by a Movement Disease Specialist (MDS) versus routine assessment. Uncontrolled and controlled states were based on the Movement Disorder Society - Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) II and III scores. Transition between health states was dependent on improvement in MDS-UPDRS II and III, and transition to death state on all cause-mortality and PD-specific relative mortality risk. Markov cycle length was yearly beyond year 1 and lifetime horizon 22 years.

Limitations: PKG evidence incorporated in this analysis is based on findings from one clinical trial. Health state utilities were mapped and the probability of patients progressing from uncontrolled to controlled health state at the second visit and beyond was derived from a bootstrap method which assumed a normal distribution for MDS-UPDRS.

Results: The addition of the PKG to usual PD assessments is a cost-effective intervention. PKG plus routine assessment is associated with lower total costs compared to routine assessment (£141,950 versus £159,312) and improved quality adjusted life years (7.88 versus 7.61), resulting in an incremental cost-effectiveness ratio of -£64,978.99 and a net monetary benefit of £22,706.37 using a £20,000 threshold. Results were robust across sensitivity and scenario analyses.

Conclusions: Management of PD involves monitoring and evaluation of symptoms to assess disease progression and ensure appropriate treatment choice. Adding the PKG to clinical assessment in routine care allows for improved and objective identification of PD motor symptoms which can be used in clinical decision making to improve patient outcomes.

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