Estimating economic efficiency of preclinical diagnostics of Parkinson's disease with cost-utility approach

Abstract

Neurodegenerative diseases, Parkinson disease among them, set challenges to modern societies both in terms of premature deaths and resources spent on treatment of the diseases. At that, preventive care and early diagnostics in particular are potential directions towards higher economic efficiency of healthcare interventions in this area. Authors of this paper suggest a modification of the cost-utility approach to evaluate economic efficiency of an early diagnostics at the presymptomatic (prodromal) stage of Parkinson disease (PD), when its symptoms do not appear clinically yet. Such diagnostics, in combination with neuroprotective therapy for persons at high risk of PD, allows postponing its development until later years, and thereby ensuring an improvement in the quality of life of the population, as well as saving resources of the healthcare system and society as a whole. The authors rely on the diagnostic approach proposed by the research group headed by M. Ugryumov, which is currently at the stage of laboratory testing. Its implementation potentially leads to savings in both direct and indirect costs for PD treatment compared to the traditional approach, but increases testing costs, and also requires the development of new neuroprotective therapy for identified risk groups. The authors propose a modification of the cost-benefit assessment procedure to take into account the uncertainty associated with the lack of a final understanding of the scope and composition of the testing group at the preclinical stage. The condition for the economic efficiency of the preclinical diagnostic method in the developed procedure is the minimum permissible probability of detecting an increased risk of PD in the test group. To test their algorithm, the authors carry out calculations basing on the Russian data.

Incidence of Parkinson disease in North America

“…To ensure those with PD are diagnosed early, brief tools for parkinsonism screening in routine primary care clinical practice, such as those for dementia 46 , are needed. This is especially true given the evidence that early diagnosis of parkinsonism secondary to PD associates with improved patient outcomes and clinician decision making [47][48][49][50][51] . Symptomatic cognitive dysfunction or dementia, due to Alzheimer disease, vascular dementia, toxic or metabolic cognitive dysfunction, increases with age 52 and becomes very prevalent in the 8 th decade and beyond 12,53,54 .…”