Swedish guidelines for device‐aided therapies in Parkinson's disease —Economic evaluation and implementation

Abstract

Objectives The National Board of Health and Welfare in Sweden published the national guidelines for Parkinson's Disease 2016. The aim of this study was to summarize this evidence review and development of the guidelines, focusing on the economic evaluation of device‐aided therapies (deep brain stimulation, pump‐based infusion of levodopa‐carbidopa intestinal gel or apomorphine) for Parkinson's disease, and the rate of implementation after 3 years in Sweden. Material and methods The evidence review underlying the guidelines—including systematic literature searches of clinical and economic evidence, model‐based economic evaluation, and formal analysis and guideline development—was examined, condensed, and translated. The impact of the guidelines was assessed with treatment use statistics from 2009 to 2019. Results All device‐aided therapies were assigned high priority. Based on a relatively low proportion of device‐aided therapies (30%) in Parkinson's disease, a 5‐year increase of 500 patients was recommended. This was estimated to reduce total costs by SEK 14 million (€1.7 million). Follow‐up data found an increase of 217 patients between 2017 and 2019, following the same trend as before the guidelines. Conclusion Three years after the guidelines were published, the use of device‐aided therapies has increased in Sweden, albeit not in pace with recommendations. One reason for slow implementation may be poor incentivization related to budget silos in which the costs for device‐aided therapies are borne by the regions but the cost offsets (eg, reduced need for home care) are reaped by local stakeholders.

Levodopa–entacapone–carbidopa intestinal gel infusion in advanced Parkinson’s disease: real-world experience and practical guidance

“…An analysis of prescription of DATs in Sweden published in 2021 found that while their use has increased in Sweden since evidence-based treatment guidelines were published in 2016, it is still not at the levels suggested in these recommendations. 22 …”

“…Sweden has a National Parkinson’s Disease Patient Registry (PARKreg) as part of the Swedish Neuro Registry ( https://www.neuroreg.se ). 22 So far, more than 100 patients on LECIG are registered in Sweden. Alongside the launch of LECIG infusion, a prospective, noninterventional, observational pan-European study has been established.…”

Accessibility of Device-Aided Therapies for Persons With Parkinson’s Disease in Poland

“…20 In view of the cost-effectiveness of DAT therapies, 10 this is an encouraging development, especially taking into account the recommended use of DAT. 14 The barriers to and the possible reasons for underutilization of DAT in Poland remain unclear, but it can be speculated that several factors may be involved: 1) the relatively high initial costs of DAT 6 ; 2) the limited availability of DATs; 3) the relatively low number of specialized movement disorder neurologists 10 ; 4) a conservative approach to PD treatment in general 15 ; 5) the low number of referrals by general neurologists and general practitioners due to limited knowledge about DAT 21,22 ; and 6) limited knowledge about DAT among persons with PD. 23 While using a national registry helps minimize selection bias, there are still some limitations to consider.…”

A New Paradigm in Parkinson's Disease Evaluation With Wearable Medical Devices: A Review of STAT-ONTM

“…The diagnosis of early fluctuations and dyskinesia is delayed in many cases due to multiple circumstances, such as the short neurology visits and the lack of optimal tools, which can allow for precise symptom identification. This circumstance is also present in advanced stages, where there is also an infradiagnosis of advanced symptoms ( 9 , 10 ). So far, the identification and quantification of MF can be measured through patient diaries (e.g., Hauser diaries) and/or by a set of validated scales, such as the Unified Parkinson's Disease Rating Scale (UPDRS) ( 11 , 12 ).…”