Prospective study on cost-effectiveness of home-based motor assessment in Parkinson’s disease

Abstract

Introduction Treatment adjustments in Parkinson's disease (PD) are in part dependent on motor assessments. The aim of this study was to evaluate the cost-effectiveness of home-based motor monitoring plus standard in-office visits versus in-office visits alone in patients with advanced PD. Methods The procedures consisted of a prospective, one-year follow-up, randomized, case-control study. A total of 40 patients with advanced PD were randomized into two groups: 20 patients underwent home-based motor monitoring by using wireless motion sensor technology, while the other 20 patients had in-office visits. Motor and non-motor symptom severities, quality of life, neuropsychiatric symptoms, and comorbidities were assessed every four months. Direct costs were assessed using a standardized questionnaire. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Results Both groups of PD patients were largely comparable in their clinical and demographic variables at baseline; however, there were more participants using levodopa-carbidopa intestinal gel in the home-based motor monitoring group. There was a trend for lower Unified Parkinson's Disease Rating Scale functional status (UPDRS II) scores in the patients monitored at home compared to the standard clinical follow-up ( p = 0.06). However, UPDRS parts I, III, IV and quality-adjusted life-years scores were similar between both groups. Home-based motor monitoring was cost-effective in terms of improvement of functional status, motor severity, and motor complications (UPDRS II, III; IV subscales), with an ICER/UPDRS ranging from €126.72 to €701.31, respectively. Discussion Home-based motor monitoring is a tool which collects cost-effective clinical information and helps augment health care for patients with advanced PD.

Management of Advanced Therapies in Parkinson's Disease Patients in Times of Humanitarian Crisis: The COVID‐19 Experience

“…It is convenient for health care centers to establish routines for video consultation (see the section on Telemedicine). Apart from the consultation, it can also be valuable to get objective and quantitative monitoring of a patient's status, 32,33 for example, monitoring the status of the PEG (Fig. 3A).…”

Systematic Review Looking at the Use of Technology to Measure Free-Living Symptom and Activity Outcomes in Parkinson’s Disease in the Home or a Home-like Environment

“…For people with PD, being tested at home could enable better appreciation of some activities of daily living (ADLs) which occur more naturally away from a clinic or lab environment [20], rare events such as falls [21], activities which impact upon wellbeing and quality of life [22] and outcomes such as sleep quality which are costly and logistically difficult to measure longitudinally in the clinic/lab. Technology deployed to the home could provide measurements to the clinician/researcher which would otherwise have required clinician time to obtain [23], have scalability to large numbers of people with PD remotely [24], and reduce the cost of clinic visit/clinical trial contacts [25]. An extrapolation is that the home setting could improve generalisability in outcome measure results, for example by increasing inclusivity towards those people living outside the radius of a clinical treatment unit.…”

“…The studies were set in the participants' real home setting with only infrequent exceptions [37][38][39][40]. Home-based testing may be beneficial in PD partly to cater for those patients who are limited geographically or practically from attending frequent clinic assessments [103], partly to save costs [25] and importantly to achieve ecological validity in the assessment of PD symptoms which are poorly captured in 'snap-shot' reviews in a laboratory or clinic environment [8].…”

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“…Studies have shown high acceptance and usage compliance of wearable sensors by individuals with PD [26–28]. A recent study demonstrated that home-based motor monitoring can provide cost-effective clinical information and help enhance care for patients with advanced PD [6]. Likewise, studies have shown live videoconferencing may be able to provide similar clinical benefit to in-person care for patients with PD [3, 29–31].…”