Evaluation of the efficacy and cost-effectiveness of safinamide versus rasagiline: a systematic review.

Aim: This systematic review aimed to evaluate the comparative efficacy, safety and cost-effectiveness of safinamide (50/100 mg) versus rasagiline (1 mg) in managing Parkinson's disease (PD). Materials & methods: Randomized clinical trials were identified through systematic searches of PubMed, Embase and Cochrane databases (last searched September 2023). Eligibility criteria included studies assessing Unified Parkinson's Disease Rating Scale (UPDRS) scores, On/Off time and adverse events. Risk of bias was evaluated using funnel plots, and data synthesis employed odds ratios, number needed to treat (NNT) and incremental cost-effectiveness ratios, calculated using the current costs of safinamide and rasagiline in Spain.

Results

Thirteen trials (n = 4157 participants) were included. Safinamide demonstrated greater efficacy (NNT-UPDRS: 6 vs 8) and safety (number needed to harm-serious adverse events: 135 vs 83) compared with rasagiline. The benefit-risk balance of safinamide was superior, as evidenced by higher likelihood of being helped over harmed ratios. Cost-effectiveness analysis revealed lower costs per NNT for On/Off time with safinamide. While rasagiline treated more patients within a fixed budget, safinamide achieved better responder-to-nonresponder ratios.

Conclusion

Safinamide showed superior efficacy, safety and cost-efficiency compared with rasagiline, supporting its use as a preferred adjunct therapy for PD. Limitations include reliance on clinical trial data and Spanish cost models. Future research incorporating real-world evidence is warranted.