The health burdens of Parkinson's disease

Movement Disorders, 2006

We evaluated medical utilization and economic burden of self-reported Parkinson's disease (PD) on patients and society. Using the 1992-2000 Medicare Current Beneficiary Survey, we compared health care utilization and expenditures (in 2002 U.S. dollars) of Medicare subscribers with and without PD, adjusting for sociodemographic characteristics and comorbidities. PD patients used significantly more health care services of all categories and paid significantly more out of pocket for their medical services than other elderly (mean Ϯ SE, $5,532 Ϯ $329 vs. $2,187 Ϯ $38; P Ͻ 0.001). After adjusting for other factors, PD patients had higher annual health care expenses than beneficiaries without PD ($18,528 vs. $10,818; P Ͻ 0.001). PD patients were more likely to use medical care (OR ϭ 3.77; 95% CI ϭ 1.44 -9.88), in particular for long-term care (OR ϭ 3.80; 95% CI ϭ 3.02-4.79) and home health care (OR ϭ 2.08; 95% CI ϭ 1.76 -2.46). PD is associated with a significant economic burden to patients and society. Although more research is needed to understand the relationship between PD and medical expenditures and utilization, these findings have important implications for health care providers and payers that serve PD populations.

Movement Disorders, 2020

ABSTRACTBackgroundCurrent understanding of the health care costs of Parkinson's disease (PD) and the incremental burden of advanced disease is incomplete.ObjectivesThe aim of this study was to assess the direct economic burden associated with advanced versus mild/moderate PD in a prevalent national sample of elderly U.S. Medicare beneficiaries with a PD diagnosis.MethodsAnalyzing 100% fee‐for‐service Medicare claims from 2013, we defined advanced PD with a medication‐based algorithm and calculated all‐cause and PD‐related costs for the overall sample and by disease severity. We measured primary PD‐related costs (based on claims with a primary diagnosis of PD) and any PD‐related costs (based on claims with PD in any diagnostic field). Generalized linear models were used to estimate risk‐adjusted mean cost differences between the advanced and mild/moderate PD groups for the calendar year.ResultsThe final sample (N = 144,703) had mean observed all‐cause, primary PD‐related, and any...

Drugs - Real World Outcomes, 2024

Background Parkinson's disease is now one of the fastest-growing neurodegenerative disorders in the developed world, with an increasing prevalence and associated socioeconomic costs. Progression of the disease leads to a gradual deterioration in patients' quality of life, despite optimal treatment, and both medical and societal needs increase, often with the assistance of paid and/or unpaid caregivers. Objective We aimed to quantify the incremental economic burden of Parkinson's disease by disease severity in a real-world setting across differing geographic regions. Methods Demographics, clinical characteristics, health status, patient quality of life, caregiver burden, and healthcare resource utilization data were drawn from the Adelphi Parkinson's Disease Specific Program™, conducted in the USA, five European countries, and Japan. Results A total of 563 neurologists provided data for 5299 individuals with Parkinson's disease; 61% were male, with a mean age of 64 years. Approximately 15% of individuals were deemed to have advanced disease, with significantly more comorbidities, and a poorer quality of life, than those with non-advanced disease. Overall, the mean annual healthcare resource utilization increased significantly with advancing disease, and resulted in a threefold difference in the USA and Europe. The main drivers behind the high economic burden included hospitalizations, prescription medications, and indirect costs. Conclusions People with Parkinson's disease, and their caregivers, incur a higher economic burden as their disease progresses. Future interventions that can control symptoms or slow disease progression could reduce the burden on people with Parkinson's disease and their caregivers, whilst also substantially impacting societal costs.

Movement Disorders, 2002

We estimated resource use and costs in patients with Parkinson's disease (PD), thereby providing baseline data for future economic evaluations of therapeutic interventions. Data were collected from medical records of a South Swedish cohort of 127 PD patients during 1 year (1996) and a mailed questionnaire inquiring about cost-related consequences and resource use in 1996 and in 2000. Annual costs were calculated based on prevalence and expressed in SEK (monetary value of the year 2000). Direct health care costs averaged approximately SEK 29,000 (≈USD 2,900; EUR 3,200) per patient per year, of which drugs were the most costly component. Nonmedical direct costs were higher than direct health care costs, averaging approximately SEK 43,000 (≈USD 4,300; EUR 4,800) per patient per year, and costs due to lost production were approximately SEK 52,000 (≈USD 5,200; EUR 5,800) per patient per year. The mean total annual cost for PD in our sample approximated SEK 124,000 (≈USD 12,400; EUR 13,800) per patient. These findings are roughly within the same range as estimates from other countries and show that PD causes a considerable societal burden. In addition to other outcomes, evaluations of the economic implications of new therapeutic interventions are highly warranted. In this perspective, the present study provides valuable baseline data.

Movement Disorders, 2000

BACKGROUND: Adequate provision of appropriate healthcare resources for patients with chronic neurologic disorders such as Parkinson's disease (PD) requires knowledge of the impact of the illness on their life. Quality of life (QoL) instruments measure the impact of the disease on general wellbeing that cannot be fully appreciated by clinical rating scales and allow comparisons with other patient groups and the general population.

Patient Related Outcome Measures

Background: Parkinson's is an incurable, neuro-degenerative condition with multiple symptoms substantially impacting on living conditions and quality of life (QoL) for people with Parkinson's (PwP), most whom are older adults, and their families. The study aimed to undertake a literature review of studies conducted in the UK that quantify the direct or indirect impact of Parkinson's on people with the condition, their families, and society in terms of out-of-pocket payments and financial consequences. Methods: Literature was searched for Parkinson's-related terms plus condition impact (eg, financial, employment, pension, housing, health care costs, and QoL) in the UK setting. The strategy probed several electronic databases with all retrieved papers screened for relevancy. The instruments used to measure patient-related outcomes were then examined for their relevancy in justifying the results. Results: The initial search retrieved 2,143 papers of which 79 were shortlisted through title and abstract screening. A full-text reading indicated 38 papers met the inclusion and quality criteria. Summary data extracted from the articles on focus, design, sample size, and questionnaires/instruments used were presented in four themes: (a) QoL and wellbeing of PwP, (b) QoL and wellbeing of caregivers and family members, (c) employment and living conditions, and (d) direct and indirect health care and societal cost. Conclusion: UK results substantiated global evidence regarding the deterioration of QoL of PwP as the condition progressed, utilizing numerous measures to demonstrate change. Many spouses and family accept care responsibilities, affecting their QoL and finances too. The review highlighted increased health care and privately borne costs with condition progression, although UK evidence was limited on societal costs of Parkinson's in terms of loss of employment, reduced work hours, premature retirement of PwP and caregivers that directly affected their household budget.

PLoS ONE, 2014

Background: Patient reported outcomes and costs of illness are useful to capture some of the multiple effects of a disease and its treatments. Our aim was to assess quality of life (QoL) and costs of Parkinson's disease (PD) in Hungary, and to analyze their associations.

Journal of Neurology, 2011

Parkinson's disease (PD) and atypical parkinsonism (AP) cause a significant socioeconomic burden, but there is insufficient information about the total disease burden at a national level. Thus, the goal of this study was to estimate the excess direct and indirect costs of PD and AP in a national sample. Using records from the Danish National Patient Registry (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007), 13,400 PD and 647 AP patients were identified and compared with, respectively, 53,600 and 2,588 control cases randomly selected with respect to age, gender, civil status, and geographic location. Direct costs including frequencies of primary and sector contacts and procedures, and medication from primary and secondary sectors were obtained from the Danish Ministry of Health, the Danish Medicines Agency, and the National Health Security. Indirect costs, which included labor supply and social transfer payments, were based on income data derived from the Coherent Social Statistics. Patients with PD and AP had significantly higher rates of health-related contact and medication use and a higher socioeconomic cost. Furthermore, they had very low employment rates, and those in employment had a lower income level than employed control subjects. The annual mean excess health-related cost was €6,500 ($8,975/ £5,543) and €9,771 ($13,491/£8,332) for each patient with PD and AP, respectively. In addition, the patients with PD and AP received an annual mean excess social transfer income of €324 (£276/$447) and €844 (£719/$1,165), respectively. The employment-and health-related consequences could be identified up to 8 years before the first diagnosis and increased with disease advancement. PD and AP have major socioeconomic consequences for patients and society. The health effects are present for up to more than 8 years before a diagnosis of PD/AP.

Acta Neurologica Scandinavica, 2016

Objectives-Individuals with Parkinson's disease (PD) become unavailable in the workforce earlier than comparable members of the general population. This may result in significant social insurance expenses, but as workforce participation can be a source for social interaction and a vital part of the personal identity, there are likely to be personal implications extending far beyond the economic aspects. This study aimed to identify aspects that may contribute to workforce unavailability in people with PD. Materials & methods-This was a cross-sectional registry study using data from the Swedish national quality registry for PD and included persons with PD in Sk ane County, Sweden who were younger than 65 years. Variables were selected from the registry based on earlier studies and clinical experience and were tested for association with unavailability in the workforce: first in a series of simple regression analyses and then in a multiple logistic regression analysis. Results-A total of 99 persons with PD-of whom 59 were available and 40 were unavailable in the workforce-were included in the study. Age (OR per year: 1.47, 95% CI: 1.18-1.85; P < 0.01) and anxiety (OR: 6.81, 95% CI: 1.20-38.67; P = 0.03) were significant contributing factors for unavailability in the workforce. Conclusions-Based on the findings in this exploratory study, anxiety-a potentially modifiable factor-and age may be contributing factors for workforce unavailability in PD. However, prospective studies are warranted to confirm the findings and the causation of the association between anxiety and workforce unavailability needs to be clarified.

Movement Disorders, 2006

The objective was to provide population-based estimates of incremental medical costs associated with Parkinson's disease (PD) from onset forward. All Olmsted County, Minnesota, residents with confirmed PD onset from 1987 through 1995 (n ϭ 92) and one age-and sex-matched non-PD referent subject per case were identified with retrospective record review and followed in provider-linked billing data for direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before index (i.e., year of symptom onset) through 10 years after index. Costs for each referent subject were subtracted from those for his/her matched case. Tests for statistical significance used Wilcoxon signed ranks. Preindex costs were similar [median difference in annual costs (MD) ϭ Ϫ$3; P ϭ 0.59]. One year post index, PD subjects exhibited borderline significantly higher costs compared to referent subjects (MD ϭ $581; P ϭ 0.052); the difference diminished over 5 years (MD ϭ $118; P ϭ 0.82). By 5 to 10 years, however, PD subjects exhibited significantly higher costs (MD ϭ $1,146; P ϭ 0.01). Over the full 10 years, excess costs were concentrated among PD subjects without rest tremor (MD ϭ $2,261, P Ͻ 0.01, for those without tremor and Ϫ$229, P ϭ 0.99, for those with tremor). These population-based estimates of PDassociated direct medical costs from onset forward can uniquely inform policy decisions and cost-effectiveness research.

European Neuropsychopharmacology, 2011

We investigated the costs of Parkinson's Disease (PD) in 486 patients based on a survey conducted in six countries. Economic data were collected over a 6-month period and presented from the societal perspective. The total mean costs per patient ranged from EUR 2620 to EUR 9820. Direct costs totalled about 60% to 70% and indirect costs about 30% to 40% of total costs. The proportions of costs components of PD vary notably; variations were due to differences in country-specific health system characteristics, macro economic conditions, as well as frequencies of resource use ⁎ Corresponding author.

Journal of Aging Science, 2015

Background: Globally there are few reports of the impairments, disabilities and medications used in people living with idiopathic Parkinson's disease. Caregiver characteristics and caregiver burden have seldom been reported. We examined the health status in a large cohort of people living with Parkinson's disease and their caregivers managed in a comprehensive health care setting. Methods/Design: A prospective, cross sectional analysis of impairments, disabilities and Parkinson's disease medication use was conducted in a sample of 100 people with Parkinson's disease rated I-IV on the modified Hoehn & Yahr scale. Participants were recruited from the Victorian Comprehensive Parkinson Program in Melbourne, Australia. Their caregivers were invited to provide their views on the burden of care, services provided and support received. Results: The severity of impairments and disabilities was strongly associated with disease duration (mean of 5.5 years). Those with long standing disease or more severe disease also used more Parkinson's disease medications and participated in fewer social roles than people who were newly diagnosed or mildly affected. The severity of impairments was strongly correlated with limitations in performing activities of daily living. Limitations in performing daily activities were also found to be a significant contributing factor for health-related quality of life (PDQ-39 SI β=0.55, p=0.000; EQ-5D SI β=0.43, p=0.001). People with Parkinson's disease lived at home with relatives. The average caregiver was a spouse or child providing approximately 3.5 hours of care per day, with the capacity to provide 9.4 hours per day and had provided care for four years. Additional support was high (63%) for 2.5 hours per day. Conclusion: The comprehensive care setting of this cohort describes a relatively benign condition despite a wide range of disease duration and severity. This report provides a baseline with which to compare other delivery models.

European Neurological Review, 2012

Parkinson&#39;s disease (PD) is the second most common neurodegenerative disorder worldwide. With a progressive course and no cure yet available, it is demanding for patients and their caregivers, but also for health and social support systems and ultimately for society as a whole. Everyday significant economic resources are spent due to PD, either directly on its treatment or in lost productivity. In this article, one tried to frame PD from an health economics&#39; perspective and cost of illness studies conducted in 11 countries (Austria, Czech Republic, Finland, France, Germany, Italy, Portugal, Russia, Sweden, UK and US), published from 1998 to 2011, were reviewed. One main aspect subsists: costs associated with this disorder are high, disproportionately higher that its prevalence and PD poses a substantial economic burden on individuals and society.

Background: The disability inherent to Parkinson's disease and dementia would suggest poor health-related quality of life for patients with these neurodegenerative conditions; however, the extent of disability from a nationally representative data has not been previously available. Objectives: This study examined factors associated with the health-related quality of life in patients with Parkinson's disease and dementia using nationally representative samples. Methods: The study used data from 2002 to 2011 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of households in the United States. The quality of life of patients was captured based on Physical Component Summary (PCS), Mental Component Summary (MCS), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Multivariate regression models were used to compare PCS, MCS, ADL and IADL across the two neurodegenerative conditions after controlling for various sociodemographic and clinical characteristics. Results: The weighted study population included 0.80 million (95% Confidence Interval, CI: 0.75–0.85) patients; those with Parkinson's disease accounted for 40.23% and remaining 59.77% were diagnosed with dementia. Mean age of the study population was 74.32 years (Standard Deviation, SD ¼ 11.36). Most of the Parkinson's patients were male (57.70%), whereas most of the dementia patients were females (58.10%). The unadjusted mean PCS was 33.66 and 35.31 in Parkinson's and dementia patients, respectively (P ! 0.01). Patients with Parkinson's disease were less likely to seek help for IADL than neurodegenerative dementia (Odds Ratio, OR ¼ 0.68, P ¼ 0.02). Various other individual, biological and environmental factors were also associated with quality of life in patients with Parkinson's disease and neurodegenerative dementia. Conclusions: This study found that patients with Parkinson's disease had lower PCS and were less likely to seek help for IADL when compared to the patients with neurodegenerative dementia. Knowledge of these factors can be helpful in improving quality of life of patients with neurodegenerative diseases.

Quality of Life Research, 2012

PurposeTo identify the demographic factors, impairments and activity limitations that contribute to health-related quality of life (HRQOL) in people with idiopathic Parkinson’s disease (PD).MethodTwo hundred and ten individuals with idiopathic PD who participated in the baseline assessment of a randomized clinical trial were included. The Parkinson’s Disease Questionnaire-39 summary index was used to quantify HRQOL. In order to provide greater clarity regarding the determinants of HRQOL, path analysis was used to explore the relationships between the various predictors in relation to the functioning and disability framework of the International Classification of Functioning model.ResultsThe two models of HRQOL that were examined in this study had a reasonable fit with the data. Activity limitations were found to be the strongest predictor of HRQOL. Limitations in performing self-care activities contributed the most to HRQOL in Model 1 (β = 0.38; p &lt; 0.05), while limitations in fu...