The Value of Care in Parkinson’s Disease
Figure 1: Cost Per Case of Different Brain Disorders in Europe3 40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
Source: Reproduced with permission from John Wiley & Sons.3
Table 1: Socioeconomic Consequences of Dementia in Parkinson’s Disease, as Measured in the European Cost of Illness Study (Data From Germany)
Characteristic Inpatient stay
Inpatient rehabilitation Physician visits Drug costs (€)
Quality of life (measured by EQ-5D) Carer working
Carer with morbidity
Dementia No Dementia (MMSE ≤25) (MMSE >25)
17.5 % 18 % 9
4,015 56 % 12 % 46 %
Carer quality of life (measured by EQ-5D) 74 %
10 % 5 % 8
3,120 63 % 26 % 26 % 82 %
EQ-5D = European quality of life-5 dimensions; MMSE = mini mental state examination.
populated countries such as India and China by 20305 in an even greater financial impact in the near future.
– this will result
A more recent European study has assessed the cost of PD in a survey of movement disorder units in Austria, the Czech Republic, Germany, Italy and Portugal (plus two non-EU countries, Russia and the US).6–9
Costs per patient per year ranged from €2,620 in Russia to €9,810 in Austria, but in all countries there was a clear correlation between increasing cost and higher Hoehn and Yahr stage. The components of cost varied between countries – for example, inpatient costs constituted a greater proportion of costs in Germany and Portugal than in other countries, medication costs made up the largest proportion of costs in Germany but not in other countries and the costs of care accounted for a greater proportion of costs in the Czech Republic and Italy than in other countries – but indirect costs
14
were consistent. Dopamine agonists are expensive drugs to use (compared with levodopa) and variations in PD medication used in different countries explain why medication costs make up different proportions of the total costs (see Figure 2). In Germany, dopamine agonists are used more frequently than in other countries (see Figure 2). However, these data reflect practices in the major specialist centres and in smaller centres (such as in rural areas) management practices may vary – for example, in Germany the use of dopamine agonists is considerably less frequent in the smaller centres than Figure 2 would suggest.
When assessing the impact of complications on the costs of PD, data from the German participants in the European cost of illness study showed that dyskinesias doubled the cost per patient per year from €5,040 (for those with no dyskinesia) to €10,760, and motor fluctuations increased cost per patient per year from €6,040 to €11,040. Psychiatric diseases are known to increase the odds ratio (OR) of a patient with PD going into a nursing home (OR 2–2.5 with dementia; OR 17 with psychosis).10,11
Nursing home care and other institutionalised care is expensive, and this again highlights the need to consider such patients, who may not always be included in cost analyses. In the European cost of illness study (German part), the costs associated with PD patients with dementia (mini mental state examination [MMSE] scores ≤25) were higher at all age groups than those associated with patients with MMSE scores >25. Factors that may have influenced this increased cost in patients with dementia are listed in Table 1. Interestingly, the presence of dementia had a minor impact (or in some cases no impact) on some direct costs, such as the number of visits to the physician and direct drug costs, whereas the wider impact on inpatient care and on the carers is greater. Many other motor and non-motor complications, such
EUROPEAN NEUROLOGICAL REVIEW SUPPLEMENT
Cost per patient (€ 2004)
Tumour
Multiple sclerosis
Stroke Dementia
Psychotic disorders
Parkinson’s disease
Epilepsy
Affective disorders
Trauma Addiction
Anxiety disorders
Migraine
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39