Data_Sheet_1.pdf

Frontiers in Neurology, 2018

Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of PD, or one physician diagnosis confirmed by a subsequent or independent diagnosis or by PD medication in 2015. Prevalence of (co-)occurring diseases, mortality, and healthcare measures in PD cases and matched controls were compared. In 2015, 21,714 prevalent PD cases (standardized prevalence: 511.4/100,000 persons) and 3,541 incident PD cases (standardized incidence: 84.1/100,000 persons) were identified. Prevalence of several (co-)occurring diseases/complications, e.g., dementia (PD/controls: 39/13%), depression (45/22%), bladder dysfunction (46/22%), and diabetes (35/31%), as well as mortality (10.7/5.8%) differed between PD cases and controls. The annual healthcare utilization was increased in PD cases compared to controls, e.g., regarding mean ± SD physician contacts (15.2 ± 7.6/12.2 ± 7.3), hospitalizations (1.3 ± 1.8/0.7 ± 1.4), drug prescriptions (overall: 37.7 ± 24.2/21.7 ± 19.6; anti-PD medication: 7.4 ± 7.4/0.1 ± 0.7), assistive/therapeutic devices (47/30%), and therapeutic remedies (57/16%). The standardized prevalence and incidence of PD in Germany as well as mortality in PD may be substantially higher than reported previously. While frequently diagnosed with co-occurring diseases/complications, such as dementia, depression, bladder dysfunction and diabetes, the degree of healthcare utilization shows Parkinson's Disease Epidemiology and Healthcare in Germany large variability between PD patients. These findings encourage a rethinking of the epidemiology and healthcare utilization in PD, at least in Germany. Longitudinal studies of insurance claims data should further investigate the individual and epidemiological progression and healthcare demands in PD.

PharmacoEconomics, 2005

Parkinson's disease (PD) in Germany over a 6-month observation period and to identify the predictors of these costs. Study design and methods: Direct and indirect costs were evaluated in 145 patients with PD (mean age 67.3 ± 9.6 years). PD patients were recruited from an outpatient department for movement disorders, a specialised PD clinic, two office-based neurologists and general practitioners, all located in Germany, and were enrolled between January and June 2000. Relevant economic data were documented in a patient diary over the 6-month period. Clinical evaluations (Unified Parkinson's Disease Rating Scale [UPDRS]) were performed at baseline and at 3 and 6 months. Costs were derived from various German medical economic resources. Costs were calculated from the perspective of healthcare and transfer payment providers and the individual patient. Indirect costs for lost productivity were also calculated. Costs are presented as means ± standard deviation (SD). Multivariate regression analyses were performed to identify independent cost predictors. Costs are in year 2000-02 values. Results: We estimated average per patient direct, indirect and total costs for the 6-month observation period. The costs from the perspective of statutory health insurance (Gesetzliche Krankenkversicherung [GKV]) consisted of direct medical costs €1370 ± €3240, including rehabilitation (€420 ± €1630), hospitalisation (€710 ± €2520), outpatient treatment (€40 ± €30), ancillary treatment (€190 ± €280) and ambulatory diagnostic procedures (€10 ± €30). In addition, parkin-818 Spottke et al. sonian drug costs were €1520 ± €1250. Non-medical direct costs calculated from the GKV perspective were estimated to be €480 ± €1710, which included transportation (€10 ± €20), special equipment (€420 ± €1640), social/ home-help services (€10 ± €110) and sickness benefit (€40 ± €540). The total medical (including drug costs) and non-medical direct costs for the GKV were €3380 ± €4230. Univariate predictors for GKV direct costs included occurrence of motor complications and falls, disease severity, nightmares and dementia. However, multivariate analyses only suggested disease severity and health-related quality of life as significant predictors. For nursing insurance, payments of €1330 ± €2890 were calculated. For retirement insurance, payments were €650 ± €1510 and there were patient (or caregiver) costs of €1490 ± €2730. Total indirect costs amounted to €3180 ± €6480. Conclusion: According to our study, PD puts a high financial burden on society and underscores the need for further economic and medical research to optimise treatment for PD. Parkinson's disease (PD) is one of the most com-evaluated the economic impact of PD; [12-19] howevmon neurodegenerative diseases, with an estimated er, no comprehensive study evaluating direct and prevalence of 66-258 per 100 000. [1] The main indirect costs of PD has been conducted in Germasymptoms of PD are bradykinesia, rigidity, rest ny. Further, earlier studies have focused mainly on tremor and postural instability. [2] Except for postural the impact of motor function and complications on instability, these symptoms are treatable in the early healthcare utilisation of PD patients, with scant atstages of the disease by use of dopaminergic drugs. tention paid to factors predicting the costs of the After 2-5 years, however, almost 50% of PD pa-disease. [19,20] tients develop motor complications, [3-5] including The aim of the present study was to prospectively dyskinesias (involuntary movements) and motor evaluate the direct and indirect costs over a 6-month fluctuations (loss of mobility). Along with these period for a group of patients with PD, with a focus motor complications, mental disorders (psychosis, on identifying the main predictors of these costs in depression, cognitive dysfunction), autonomic dysthe German healthcare system. function (bladder disturbance, orthostatic hypotension, gastrointestinal dysfunction) and sleep distur-Patients and Methods bance may complicate the course of the disease and its treatment. [2,6-10] While PD affects primarily the Clinical Evaluation older population, up to 10% are aged <50 years at disease onset. [11] No cure has been found to stop the Between January and June 2000, 145 patients progressive course of the disease, and severe disa-(97 male, 48 female) with idiopathic PD were conbility may occur in its later stages. secutively recruited in the county of North Hessia, The progressive and long-term nature of PD Germany. Initially, every PD patient in the different amounts to a substantial financial burden for the centres was asked to participate in the study (perindividual patients and healthcare providers, and in centage of recruitment: ~80%). To ensure an adeterms of retirement insurance. Several studies have quate number of patients in the difficult to recruit Cost of Parkinson's Disease in Germany 819 very early (Hoehn and Yahr [HY] stage I [HY I]) drug, medical and non-medical costs) and indirect and very late stages of the disease (HY V), we costs were considered. All healthcare use was rescreened the patient files for additional patients. corded; however, only PD-specific costs were con-Study sites included an outpatient department for sidered for the cost analysis. The data were calculatmovement disorders (Department of Neurology, ed for different perspectives, including those of Philipps-University, Marburg [n = 29]), a special-Gesetzliche Krankenversicherung (GKV) [statutory ised PD clinic (the Paracelsus Elena Clinic, Kassel health insurance], Pflegeversicherung (PV) [nursing [n = 31]), two office-based neurologists (n = 40) and care insurance], Rentenversicherung (RV) [retire-12 general practitioners (n = 45). ment insurance] and individual patients. In addition, indirect costs were calculated. All costs were calcu-Each patient underwent a complete medical and lated for the 6-month period in € with year neurological examination, including a uniform, 2000-2002 values. structured assessment of parkinsonian signs and symptoms conducted by a movement disorders spe-Seven patients were lost to observation after the cialist. PD diagnosis was based on clinician judge-3-month follow-up. Costs for these patients were ment according to the UK Parkinson's Disease Soci-extrapolated for the 6-month period. ety Brain Bank clinical diagnostic criteria for PD. [21]

Archives of Gerontology and Geriatrics, 2009

Neurological Research and Practice

Background Parkinson’s disease (PD) is a progressive, neurodegenerative disorder. In the advanced stages it can result in severe disability despite optimal treatment. Data suggests heterogeneous classification of PD stages among physicians in different countries. The purpose of the OBSERVE-PD study was to evaluate the proportion of patients with advanced PD (APD) according to physicians’ judgments in an international cohort. Methods A cross-sectional, observational study was conducted in 18 countries. Data were collected during a single patient visit. Demographic data, disease status, current medical treatment, and quality of life were evaluated for the German cohort and compared to the international cohort. Potential prognostic factors of physicians’ classification of APD in the German and international cohorts were identified using logistic regression. Results In total, 177 German and 2438 international patients were enrolled. 68.9% of the German and 50.0% of the international pat...

BMC health services research, 2005

Background: Parkinson's disease (PD) is a chronic neurodegenerative disease which at present has no cure, and it usually results in severe disability. The burden of PD increases as the illness progresses, resulting in the extensive utilisation of both health and community services. Knowledge of healthcare use patterns and of their determinants may greatly contribute to improve patient care, however few studies have examined this issue in PD. The present study was devised to describe the type of and reasons for medical healthcare resource use in persons with PD attending a Centre for PD and Movement Disorders, and to examine drug prescriptions issued on such occasions.

Movement Disorders, 2005

This study quantifies direct medical care costs for individual patients with Parkinson's disease (PD) and projects total national costs of PD. Anonymous, patientlevel data on health care utilization and cost were obtained from Medstat's MarketScan Research Databases. Patients were selected for study if they had either two instances of a diagnosis of PD or one diagnosis and two or more prescriptions for PD-related medication. A control group of persons without PD was selected for comparison. Total annual health care utilization and costs were calculated for both PD patients and controls. A total of 20,016 patients with PD were identified and followed up for an average of 853 days. The mean age of the patients was 73.6 years, and 51.2% were women. Total annual direct costs were $23,101 (SD 27,529) per patient with PD versus $11,247 (SD 16,486) for controls. The regression-adjusted incremental direct cost of PD versus control was $10,349 (95% confidence interval, 9,053, 11,645). Adding $25,326 in indirect costs, and multiplying by 645,000 cases of PD in the United States, the total cost to the nation is projected to be $23 billion annually. This estimate is higher than most previous studies, with important implications for health care delivery systems worldwide.

European Neuropsychopharmacology, 2005

Objective: To provide an overview on the prevalence and incidence of Parkinson's disease (PD) in selected European countries. Background: PD is a common disease of unknown etiology. Accurate information on the epidemiology of PD is critical to inform health policy. An aging population will lead to more patients with PD; thus, the high financial burden PD places on society will increase. Material and methods: A systematic literature search was performed to identify studies on the prevalence and incidence of PD in the following European countriesUnited Kingdom. Only published studies were included. Abstracts, reviews, meta-analyses and letters to the editor were excluded. There were no language restrictions. Data were extracted using a standardized assessment form, and evidence tables were used to systematically report and compare the data. Results: Of 39 identified studies, most (87%) reported estimates of PD prevalence rates, while only a few (13%) reported estimates of PD annual incidence rates. Crude prevalence rate estimates ranged from 65.6 per 100,000 to 12,500 per 100,000 and annual incidence estimates ranged from 5 per 100,000 to 346 per 100,000. No publications could be identified for Austria or the Czech Republic. Discussion and conclusion: The observed variations in prevalence and incidence rates may result from environmental or genetic factors, but might also be a consequence of differences in methodologies for case ascertainment, diagnostic criteria, or age distributions of the study populations. The comparability of existing studies is limited. D

Frontiers in Neurology

Objectives: We set forth to estimate the number of those with Parkinson's disease (PD) in Hungary, a country with a single-payer health insurance system covering 10 million inhabitants. Methods: We analyzed all hospital and outpatient reports from neurological services and pharmacy reports of prescription refills. We cross-checked clinically administered diagnosis of PD with prescription refills of antiparkinsonian medications using record linkage. We used the ICD-10 code of G20 in any diagnostic category to find all cases with possible PD. For case certification those patients were considered to have PD who were recorded with G20 code in at least 2 calendar years. For a more conservative estimation we determined the number of those who also refilled antiparkinsonian medication. Results: Between 2010 and 2012 there were 46,383 subjects with certified PD by clinical criteria. Crude and age-standardized incidence were 49/100,000/year (95% CI: 45-53), and 56/100,000/year (95% CI: 51-60). Crude and age standardized prevalence rates were 404/100,000 (95% CI: 392-416) and 471/100,000 (95% CI: 456-485). Of all clinically certified PD patients 72% refilled antiparkinsonian medications. Discussion: The incidence and prevalence of PD in Hungary is higher than earlier estimates, which should be considered in organizing healthcare services for this patient group.

Parkinsonism & related disorders, 2012

To investigate factors associated with healthcare utilization and prescription drug use for Parkinson&#39;s disease (PD) patients and matched controls. A retrospective matched-group design was adopted using administrative data from Manitoba, Canada. PD cases (N = 1469) were identified from diagnoses in hospital records and physician billing claims and matched to controls (N = 2938) on age, sex, and region of residence. Sixteen measures of healthcare utilization were examined over a six-year period using generalized linear models. PD cases had greater healthcare utilization than controls for almost all investigated services, with the exception of visits to non-neurological specialists and hospital use for non-mental disorder diagnoses. For controls, utilization of all forms of healthcare increased with age; for PD cases the relationship was weak, except for specialist visits, where an inverse relationship was observed. A rural region of residence was associated with a lower rate of s...

American journal of epidemiology, 2016

We investigated trends in the incidence of parkinsonism and Parkinson disease (PD) by comparing data from the first 2 subcohorts of the Rotterdam Study, a prospective, population-based cohort study (first subcohort: baseline 1990 with 10 years of follow-up; second subcohort, baseline 2000 with 10 years of follow-up). From the baseline years, we observed differences in the second subcohort that were associated with a lower risk of PD for some but not all baseline risk factors. Participants in both subcohorts were followed for a maximum of 10 years and monitored for the onset of parkinsonism, the onset of dementia, or death, until January 1, 2011. We used Poisson regression models to compare the incidences of parkinsonism, both overall and by cause (PD and secondary causes), and competitive events (incident dementia and death) as well as the mortality of parkinsonism patients in the 2 subcohorts. In the 1990 subcohort, there were 182 cases of parkinsonism (84 of which were PD) during ...