Protocol of a randomized open label multicentre trial comparing continuous intrajejunal levodopa infusion with deep brain stimulation in Parkinson's disease - the INfusion VErsus STimulation (INVEST) study

D van Poppelen, V Sisodia, R J de Haan, M G W Dijkgraaf, P R Schuurman, G J Geurtsen, A E M Berk, R M A de Bie, J M Dijk, D van Poppelen, V Sisodia, R J de Haan, M G W Dijkgraaf, P R Schuurman, G J Geurtsen, A E M Berk, R M A de Bie, J M Dijk

Abstract

Background: Both Deep Brain Stimulation (DBS) and Continuous intrajejunal Levodopa Infusion (CLI) are effective therapies for the treatment of Parkinson's disease (PD). To our knowledge, no direct head-to-head comparison of DBS and CLI has been performed, whilst the costs probably differ significantly. In the INfusion VErsus STimulation (INVEST) study, costs and effectiveness of DBS and CLI are compared in a randomized controlled trial (RCT) in patients with PD, to study whether higher costs of one of the therapies are justified by superiority of that treatment.

Methods: A prospective open label multicentre RCT is being performed, with ancillary patient preference observational arms. Patients with PD who, despite optimal pharmacological treatment, have severe response fluctuations, bradykinesia, dyskinesias, or painful dystonia are eligible for inclusion. A total of 66 patients will be randomized. There is no minimal inclusion in the patient preference arms. The primary health economic outcomes are costs per unit on the Parkinson's Disease Questionnaire-39 (PDQ-39) and costs per unit Quality-Adjusted Life Year (QALY) at 12 months. The main clinical outcome is patient-reported quality of life measured with the PDQ-39 at 12 months. Patients will additionally be followed during 36 months after initiation of the study treatment.

Discussion: The INVEST trial directly compares the costs and effectiveness of the advanced therapies DBS and CLI.

Trial registration: Dutch Trial Register identifier 4753, registered November 3rd, 2014; EudraCT number 2014-001501-32, Clinicaltrials.gov: NCT02480803.

Keywords: Continuous intrajejunal levodopa infusion; Cost-effectiveness analyses; Deep brain stimulation; Parkinson’s disease; Patient preference trial; Randomized controlled trial.

Conflict of interest statement

JD: unconditional supplementary grants were supplied by Medtronic for the primary 1-year follow-up of the INVEST study and for the extended 3-year follow-up. The other authors have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart. CLI, Continuous intrajejunal Levodopa Infusion; DBS, Deep Brain Stimulation

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