Health State Utility Values for Sleep Disturbance and Early Morning Off Symptoms in Advanced Parkinson’s Disease: A Vignette-Based Approach Using the EQ-5D

OBJECTIVES: Parkinson’s disease (PD) is characterized by a range of motor and non-motor symptoms. As PD progresses, symptoms become increasingly difficult to control with oral medication, especially at night and morning. Studies indicate that sleep disturbance (SD) and early morning off (EMO) substantially diminish the health-related quality of life (HRQoL) in people with PD. However, health state utility values (HSUVs) quantifying the impact of these symptoms are limited and not adequately captured for use in economic modelling. The aim was to estimate HSUVs associated with SD and EMO in people with advanced PD (aPD) using the EQ-5D-5L instrument.

METHODS: Four vignettes were developed based on published literature and clinician input to represent aPD health states in an economic model: (1) No SD or EMO, (2) SD (without EMO), (3) EMO (without SD), and (4) both SD and EMO. Adults diagnosed with PD for at least 5 years, at least 2 hours/day of OFF-time, on oral PD medications, and residing in the US or UK were asked to complete the EQ-5D-5L and EQ-VAS for each vignette in an online survey. EQ-5D-5L responses were converted into US utility values.

RESULTS: 75 individuals completed the survey; 52.0% were male and 78.7% were from the US. Respondents were on average 64.3 years old, mean time since diagnosis was 9.8 years, and average OFF-time was 3.9 hours/day. Presence of SD (0.80) or EMO (0.70) resulted in lower EQ-5D-5L utilities, with presence of both valued as the lowest (0.53) compared to when both SD and EMO were absent (0.91). EQ-VAS scores followed the same trend to the EQ-5D utilities, ranging from 48.4 to 81.0.

CONCLUSIONS: HSUVs suggested a significant negative impact of SD and EMO on HRQoL. This underscores the importance to incorporate this impact in economic models for a more comprehensive assessment of treatment benefits.