Cost effectiveness of pharmacotherapies in early Parkinson's disease.

Parkinson's disease is one of the most common chronic neurodegenerative diseases. The progression of disease and the psychosocial consequences exert a major impact on patients' health-related quality of life. Although levodopa provides the best symptomatic benefit with the fewest short-term adverse effects, long-term treatment results in motor complications that are associated with both higher costs and considerable increase in patients' discomfort. The introduction of dopamine agonists early in the treatment of Parkinson's disease leads to a delay of these motor complications, but the treatment is associated with higher costs.In this review we evaluate available cost-effectiveness analyses of the dopamine agonists pramipexole, pergolide, bromocriptine, ropinirole, cabergoline and levodopa in the treatment of early Parkinson's disease. Considerable methodological differences in the identified studies complicate a comparison and impede clear evidence as to which dopamine agonist treatment is the most cost effective in early Parkinson's disease. Novel head-to-head comparisons considering the actual treatment guidelines are necessary to identify the most cost-effective alternative in treating de novo Parkinson's disease patients.