Netherlands: 733051003). The authors had full independence regarding data collection, manuscript preparation, decision to publish, study design, interpretation and analysis Background: Few studies have investigated the health-related quality of life (HRQoL), resource use and costs in patients with late-stage Parkinson's disease (PD), and data from the Swedish setting are scarce.Objectives: First, we analyse the HRQoL in late-stage PD in Sweden. Second, we analyse the resource use and costs per severity level. Third, we analyse the relationship between costs and physician-and patient reported-outcome measures. Materials and methods:The study was based on Swedish data from the Care of Late-Stage Parkinsonism (CLaSP) study. The costs of healthcare contacts, drugs, formal and informal care, and productivity loss were collected over three months. Assessments at baseline were used for outcomes (EQ-5D, Hoehn and Yahr (H&Y), Schwab and England Scale, Unified Parkinson's Disease Rating Scale subscales (UPDRS) and Non-Motor Symptoms Scale (NMSS)). Costs were estimated in € 2016. Results:In total, 106 patients were included. The mean EQ-5D score in the total group was 0.24 (±0.33). The mean total cost excluding informal care per patient in the three-month period was approximately €14,097 (BCa 95% CI €12,007 and €16,039).Professional care accounted for the largest share (75 percent) of the total costs. The EQ-5D, H&Y, Schwab and England Scale, and NMSS were statistically significant predicting factors for total costs. Conclusion:Patients with late-stage PD are a vulnerable patient group that is costly to society and the impairment in patients' HRQoL is immense. Thus, healthcare decision-makers should optimize the organization and provision of healthcare for these patients.

Objective The Care of Late-Stage Parkinsonism (CLaSP) study aimed to collect qualitative and standardized patient data in six European countries (France, Germany, Netherlands, Portugal, UK, Sweden) to enable a detailed evaluation of the underexplored late stages of the disease (Hoehn and Yahr stage > 3) using clinical, neuropsychological, behavioral, and health economic data. The aim of this substudy was to provide a health economic evaluation for the German healthcare system. Methods In Germany, 228 patients were included in the study. Costs were calculated from a societal perspective for a 3-month period. Univariate analyses were performed to identify cost-driving predictors. Total and direct costs were analyzed using a generalized linear model with a γ-distributed dependent variable and log link function. Indirect costs were analyzed using a binomial generalized linear model with probit link function. Results The mean costs for the 3-month period were approximately €20,000. Informal care costs and hospitalization are approximately €11,000 and €5000. Direct costs amounted to 89% of the total costs, and the share of indirect costs was 11%. Independent predictors of total costs were the duration of the disease and age. The duration of the disease was the main independent predictor of direct costs, whereas age was an independent predictor of indirect costs. Discussion Costs in the late stage of the disease are considerably higher than those found in earlier stages. Compared to the latter, the mean number of days in hospital and the need for care is increasing. Informal caregivers provide most of the care. Clinical Trial Registration The protocol was registered at ClinicalTrials.gov as NCT02333175 on

Background: Apathy is the most frequent neuropsychiatric symptom in patients with dementia of the Alzheimer's type (DAT). We analyzed the influence of apathy on the resource use of DAT patients and their caregivers.Methods: Included were baseline data of 107 DAT patients from a randomized clinical trial on apathy treatment. The Resource Utilization in Dementia (RUD) instrument assessed costs over a 1-month period prior to baseline. Cost predictors were determined via a least absolute shrinkage and selection operator (LASSO).Results: On average, total monthly costs were €3070, of which €2711 accounted for caregivers' and €359 for patients' costs. An increase of one point in the Apathy Evaluation Scale resulted in a 4.1% increase in total costs.

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Background Within a 12‐week multicentre randomised controlled trial, standardised data on resource use of patients and their caregivers was collected using the Resource Utilization in Dementia (RUD) instrument. The aim of this study is to evaluate the insufficiently known influence of apathy on resource utilisation in Alzheimer's patients and their caregivers. Method 107 patients were included in the study. Costs were collected from a societal perspective over a four‐week period and examined depending on the Apathy Evaluation Scale‐Clinician Version (AES‐C). Using the Mann‐Whitney U and Kruskal‐Wallis tests, potential cost drivers were identified in a univariate analysis. Afterwards potential cost drivers for total costs, patient costs and caregiver costs were analysed using a generalised linear model (GLM) with a γ‐distributed dependent variable and log link function. Result The mean total costs were €3,069. The mean patient costs were €359 and were mainly related to professional services, hospitalisation and medication. The mean caregiver costs were €2,711 and were largely caused by informal care with a share of €2,509. Within the sensitivity analysis, informal care costs decreased to €1,742 and €903, respectively. The multiple regression analysis showed that Apathy, represented by the AES‐C, is a cost driving factor for total costs and caregiver costs, however not for patient costs. Conclusion Previous studies have often presented costs as a function of cognitive impairment. The present data show that apathy also has a significant influence on resource utilisation. At the same time, however, it was also shown that this influence was mainly caused by the increased resource use of the caregivers and that the resource use of the patients did not show significant changes.

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