Resource Utilization of Patients with Parkinson’s Disease in the Late Stages of the Disease in Germany: Data from the CLaSP Study

Kruse, Christopher; Kretschmer, Sabrina; Lipiński, A; Verheyen, Malte; Mengel, David; Balzer‐Geldsetzer, Monika; Lorenzl, Stefan; Richinger, Carmen; Schmotz, Christian; Tönges, Lars; Woitalla, Dirk; Klebe, Stephan; Schrag, Anette; Dodel, Richard

doi:10.1007/s40273-021-01011-y

Cited by 15 publications

(8 citation statements)

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“…These analyses did not impact the significance of the estimated parameters, but resulted in different estimates, and additionally, were less sensitive to changes in OFF states. Researchers have begun attempting to address the issue of estimating health-state costs in the more severe PD health states [ 68 ]; however, this is still an area that future analyses may wish to focus on as robust evidence is not yet available.…”

Section: Discussionmentioning

confidence: 99%

The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England

et al. 2022

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Background Parkinson’s disease is a progressive neurodegenerative disease, which significantly impacts patients’ quality of life and is associated with high treatment and direct healthcare costs. In England, levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of levodopa-responsive advanced Parkinson’s disease with troublesome motor fluctuations when available combinations of medicinal products are unsatisfactory. Objective We aimed to determine the cost effectiveness of LCIG compared to the standard of care for patients with advanced Parkinson’s disease in England, using real-world data. Methods A Markov model was adapted from previous published studies, using the perspective of the English National Health System and Personal and Social Services to evaluate the cost effectiveness of LCIG compared to standard of care in patients with advanced Parkinson’s disease over a 20-year time horizon. The model comprised 25 health states, defined by a combination of the Hoehn and Yahr scale, and waking time spent in OFF-time. The base case considered an initial cohort of patients with an Hoehn and Yahr score of ≥ 3, and > 4 h OFF-time. Standard of care comprised standard oral therapies, and a proportion of patients were assumed to be treated with subcutaneous apomorphine infusion or injection in addition to oral therapies. Efficacy inputs were based on LCIG clinical trials where possible. Resource use and utility values were based on results of a large-scale observational study, and costs were derived from the latest published UK data, valued at 2017 prices. The EuroQol five-dimensions-3-level (EQ-5D-3L) instrument was used to measure utilities. Costs and quality-adjusted life-years were discounted at 3.5%. Both deterministic and probabilistic sensitivity analyses were conducted. Results Total costs and quality-adjusted life-years gained for LCIG vs standard of care were £586,832 vs £554,022, and 2.82 vs 1.43, respectively. The incremental cost-effectiveness ratio for LCIG compared to standard of care was £23,649/quality-adjusted life-year. Results were sensitive to the healthcare resource utilisation based on real-world data, and long-term efficacy of LCIG. Conclusions The base-case incremental cost-effectiveness ratio was estimated to be within the acceptable thresholds for cost effectiveness considered for England. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-022-01132-y.

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Section: Discussionmentioning

confidence: 99%

The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England

et al. 2022

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“…In a community-based UK PD cohort, direct costs were 184% higher for HY 4-5 patients than HY 1, and indirect costs were 31% higher [ 17 ]. In the multinational European Care of Late-Stage Parkinsonism study, in which 93.9% (214/228) of participants were stage HY 4-5, the mean annualized direct care costs were €35,980 (US $42,697.43), which were 166% to 384% higher than previously reported cohorts [ 16 ].…”

Section: Introductionmentioning

confidence: 94%

“…The substantial economic burden of PD has been well described, including a 2017 analysis reporting direct medical costs of US $25.4 billion and an additional US $26.5 billion in indirect costs, including unpaid caregiving time, time spent by the patient and caregivers in contact with services, and lost productivity [ 15 ]. However, few economic analyses have been sufficiently powered to examine the costs of care in advanced PD patients, who comprise at most 6%-10% of the largest population-based studies [ 16 ]. In a community-based UK PD cohort, direct costs were 184% higher for HY 4-5 patients than HY 1, and indirect costs were 31% higher [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial

Fleisher¹,

Hess²,

Sennott³

et al. 2021

JMIR Res Protoc

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Background The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization. Objective The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care. Methods In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage–matched control dyads drawn from US participants in the longitudinal Parkinson’s Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination. Results The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway. Conclusions To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs. Trial Registration ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. International Registered Report Identifier (IRRID) PRR1-10.2196/31690

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“…LSPD has been labeled an “orphan population” due to the little data available on its care needs and the reduced number of available therapeutic options, largely due to the paucity or absence of clinical studies focused on these patients [ 1 , 2 ]. The above-described therapeutic landscape is in sharp contrast with LSPD being the patient group with the greatest impairment and level of dependence, having more complex care needs, and the highest health and economic impact among the different stages of PD stages [ 3 ]. In addition, LSPD is undoubtedly expected to have an exponential increase in its prevalence in the next few decades [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Personalized Care in Late-Stage Parkinson’s Disease: Challenges and Opportunities

Fabbri

Coelho²,

Garon

et al. 2022

JPM

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Late-stage Parkinson’s disease (LSPD) patients are highly dependent on activities of daily living and require significant medical needs. In LSPD, there is a significant caregiver burden and greater health economic impact compared to earlier PD stages. The clinical presentation in LSPD is dominated by motor and non-motor symptoms (NMS) that most of the time have a sub-optimal to no response to dopaminergic treatment, especially when dementia is present. Non-pharmacological interventions, including physiotherapy, cognitive stimulation, speech, occupational therapy, and a specialized PD nurse, assume a key role in LSPD to mitigate the impact of disease milestones or prevent acute clinical worsening and optimize the management of troublesome NMS. However, the feasibility of these approaches is limited by patients’ cognitive impairment and the difficulty in delivering care at home. The present care challenge for LSPD is the ability to offer a person-centered, home-delivered palliative care model based on Advanced Care Planning. An ongoing European multicentric project, PD_Pal, aims to address this challenge.

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Resource Utilization of Patients with Parkinson’s Disease in the Late Stages of the Disease in Germany: Data from the CLaSP Study

Cited by 15 publications

References 46 publications

The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England

The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England

Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial

Personalized Care in Late-Stage Parkinson’s Disease: Challenges and Opportunities

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