An economic model of Parkinson's disease: Implications for slowing progression in the United States

Abstract

Multiple studies describe progression, dementia rates, direct and indirect costs, and health utility by Hoehn and Yahr (H&Y) stage, but research has not incorporated these data into a model to evaluate possible economic consequences of slowing progression. This study aimed to model the course of Parkinson's disease (PD) and describe the economic consequences of slower rates of progression. A Markov model was developed to show the net monetary benefits of slower rates of progression. Four scenarios assuming hypothetical slower rates of progression were compared to a base case scenario. A systematic literature review identified published longitudinal H&Y progression rates. Direct and indirect excess costs (i.e., healthcare costs beyond what similar patients without PD would incur), mortality rates, dementia rates, and health utility were derived from the literature. Ten publications (N = 3,318) were used to model longitudinal H&Y progression. Base case results indicate average excess direct costs of $303,754, life-years of 12.8 years and quality-adjusted life-years of 6.96. A scenario where PD progressed 20% slower than the base case resulted in net monetary benefits of $60,657 ($75,891 including lost income) per patient. The net monetary benefit comes from a $37,927 decrease in direct medical costs, 0.45 increase in quality-adjusted life-years, and $15,235 decrease in lost income. The scenario where PD progression was arrested resulted in net monetary benefits of $442,429 per patient. Reducing progression rates could produce significant economic benefit. This benefit is strongly dependent on the degree to which progression is slowed.

Fibrin As a Scaffold for Delivery of GDNF Overexpressing Stem Cells to the Adult Rat Brain

“…As the elderly population grows, the incidence of Parkinson's disease is set to increase substantially in the coming decades 2 . Such projections give a renewed impetus for the need to develop innovative treatment approaches to address the underlying neurodegeneration in an effort to slow disease progression 3 .…”

Estimated Quality-Adjusted Life-Year Associated with the Degree of Activities of Daily Living in Patients with Alzheimer's Disease

“…The HSUVs in stroke and aphasia equal to 0.31, but there was no description of the severity of the disorders in this paper [14]. Johnson et al [15] described that the HSUVs in Parkinson's disease with dementia equal to 0.20. There was no description on HSUVs associated with low ADL levels in stroke with dementia or vascular dementia in the previous reports.…”

Emerging regenerative medicine and tissue engineering strategies for Parkinson’s disease

“…8 The cost of PD is estimated to be~$35 billion per year in the United States alone. 9 Recent studies have estimated that arresting PD progression would result in net monetary benefits of almost $450,000 per patient, and if PD progression was slowed by 20%, a benefit of over $75,000 per patient would be realized. 9 Pathophysiology and neuropathology Motor symptoms of PD are caused by the selective loss of dopaminergic neurons in the substania nigra pars compacta (SNpc) projecting to the dorsal striatum, which is composed of the caudate and putamen (see Fig.…”

“…As such, even with state-of-the-art management, the average duration from minimal disability to confinement to bed or wheelchair is 13 years. 9 New pharmaceutical therapies that focus on neuroprotection are being developed, although to date, there are no proven therapies to slow progression of disease. 38 In addition, these treatments would not restore innervation to the striatum, as they would not replace SNpc dopaminergic neurons that had degenerated before the onset of motor symptoms.…”