Costs of drug treatment in Parkinson's disease

Abstract

Parkinson's disease (PD) has a major socioeconomic impact on society. The chronic, progressive course of the disease, which often leads to severe disability, results in high expenses for the medical resources used for treatment, care, and rehabilitation of patients as well as reduced or lost productivity as a result of illness or premature death. In Great Britain, it has been estimated that the National Health Service spends up to 383 million pound sterling (1992) annually for the care of PD. This emphasizes the importance of assessing the costs related to this disease. A detailed knowledge of the cost allocation would provide a solid basis on which health care priorities can be rationally set. Next to hospitalization, drug treatment accounts for the highest expense for direct medical costs of PD. Therefore, this analysis focuses on the costs of drug treatment for PD. The cost analysis was based on a retrospective study of 409 patients with PD who were seen over a 1-year period in our movement disorders clinic. The cost of therapy varied considerably depending on the severity of the condition (assessed in the "off" phase), the incidence of motor fluctuations, and the type of PD. In the early stage of the disease (Hoehn and Yahr stage I [HY I]), mean daily costs for therapy were DM (German marks) 6.60, which increased in later stages of the disease (HY V) to DM 22.00. If rare cases requiring continuous subcutaneous apomorphine infusion were included, mean daily costs of patients in HY V rose to DM 32.50 (the mean daily costs of subcutaneous apomorphine-treated patients in HY V: DM 74.30). Patients with motor fluctuations accounted for higher costs (DM 16.50) compared with those without motor fluctuations (DM 7.80). With respect to the three subtypes of PD, the mean daily expenditure was DM 7.00 for the tremor-dominant type, DM 12.40 for the akinetic-rigid type, and DM 10.80 for the mixed type. In the group of 409 PD patients included in this analysis, the average daily expenditure for drug treatment totaled DM 10.70 per patient (including patients on subcutaneous apomorphine).

Costs of Parkinson’s Disease and Antiparkinsonian Pharmacotherapy: An Italian Cohort Study

“…In our study, apomorphine comprised approximately 35% of the expenditures on dopamine agonists in the last quartile of the UPDRS though the costs of other dopamine agonists did not differ substantially between early and advanced disease. Similar to previous studies, motor complications in our study were associated with higher costs of antiparkinsonian pharmacotherapy [10,36] .…”

“…One of the factors underlying this trend is that more frequent prescription of dopaminergic drugs occurs in patients with higher UPDRS scores, while another factor is that apomorphine treatment is used in advanced stages of the disease. In an earlier German study, the use of apomorphine increased drug costs in patients with Hoehn and Yahr stage V disease by a factor of 2.3 [36] . In our study, apomorphine comprised approximately 35% of the expenditures on dopamine agonists in the last quartile of the UPDRS though the costs of other dopamine agonists did not differ substantially between early and advanced disease.…”

“…Disease progression is associated with increasing costs of antiparkinsonian drugs [36] . One of the factors underlying this trend is that more frequent prescription of dopaminergic drugs occurs in patients with higher UPDRS scores, while another factor is that apomorphine treatment is used in advanced stages of the disease.…”

Practice parameter: Initiation of treatment for Parkinson’s disease: An evidence-based review [RETIRED]

“…Increasing problems with motor fluctuations also leads to use of several different medications in combination, typically at higher doses. 3,10,11 Ideally, patients should not have to choose between accepting the inevitability of dyskinesias or unacceptable levels of disability. The goal of treatment should be to obtain an optimal reduction of parkinsonism with a minimal risk of long-term side effects.…”

Young-Onset Parkinson’s Disease: Hospital Utilization and Medical Comorbidity in a Nationwide Survey

“…For some data cells, missing data lead to <714 PD cases and <2,007 control patients. 1 Because values in these cells are very small, NIS regulations do not allow publication of these actual values.…”