Economic and Health-Related Quality of Life Considerations of New Therapies in Parkinson??s Disease

Abstract

The progressive disability of Parkinson's disease results in substantial burdens for patients, their families and society in terms of increased health resource use, poorer quality of life, caregiver burden, disrupted family relationships, decreases in social and leisure activities, deteriorating emotional well-being, and direct and indirect costs of illness. Health-related quality of life (HR-QOL) measures have been used successfully in cross-sectional studies to identify and characterise these burdens; however, there is not yet substantial evidence that these instruments will be responsive to changes in patients over time and that the results will provide patients and health professionals with clinically meaningful information useful in making decisions about treatment strategies. The few studies documenting direct and indirect costs indicate increased use of ancillary health and community services, significant adaptations in home and transportation, increased use of mobility and self-care aids, and lack of access to appropriate healthcare providers. Patients with Parkinson's disease incur higher hospital expenses, have increased number of prescriptions, and experience earnings loss; the latter also applies to family caregivers. The choice, intensity and timing of therapy are determined by a variety of factors: presenting symptoms, age, employment status, comorbidity, cognitive impairment and level of functional impairment. Choices must be individually tailored to a patient's physical and personal needs. To be useful for patients with Parkinson's disease in clinical practice, clinicians should be able to use HR-QOL measures to identify appropriate medical interventions or socio-behavioural modifications to modify the HR-QOL deficits. However, while the interplay of interventions and clinical outcomes are often well understood, the effects of interventions on HR-QOL outcomes have not been studied extensively. Little research has been done that explicitly links the signs and symptoms of Parkinson's disease to the HR-QOL outcomes. The only Parkinson's disease cost-effectiveness study as yet performed indicated higher costs for patients receiving pramipexole than for those not taking the drug, but additional quality life-years were gained. Longer term effectiveness of many treatment strategies, and the usefulness of HR-QOL instruments to assess these treatments for individual patients over time, are critical areas for future research.

Loss of ability to work and ability to live independently in Parkinson’s disease

“…PD has a significant economic impact on patients, families and society [14, 19]. The most recent study on the cost of PD in the US estimated the total annual cost of the disease to be $23 billion in 2002.…”

Changes in Clinical Management and Diagnosis following DaTscan™ SPECT Imaging in Patients with Clinically Uncertain Parkinsonian Syndromes: A 12-Week Follow-Up Study

“…PD is known to interfere with various aspects of QoL in this patient population [30,31,32,33,34]. In our study, we did not observe a significant difference in EQ-5D or PDQ-39 QoL total scores between the groups at 12 weeks following DaTscan, and we did not observe a difference between patients with normal versus abnormal scans within the DaTscan imaging group, which further confirms that (1) the majority of CUPS patients were in the early stage of disease and (2) longer study duration (after change in clinical management plan) may be required to expect significant improvements in multidimensional QoL measures.…”

Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson's disease

“…[5][6][7][8][9] The variable benefit from this costly procedure raises the question of its economic consequences from a health insurance perspective. [10][11][12][13][14][15] The SPARK Study Group conducted a prospective multicentre study in a large series of PD patients who received bilateral STN stimulation. The aims of this study were to measure the economic impact of STN stimulation, to evaluate its effects on motor symptoms, quality of life, cognition, and behaviour, and to determine predictive factors of outcome following surgery.…”