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Judith Dams,
Jens Klotsche,
Bernhard Bornschein,
Jens P Reese, Monika Balzer-Geldsetzer,
Yaroslav Winter,
Anette Schrag,
Andrew Siderowf,
Wolfgang H Oertel,
Günther Deuschl,
Uwe Siebert,
Richard Dodel
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ABSTRACT: BACKGROUND: Clinical studies employ the Unified Parkinson's Disease Rating Scale (UPDRS) to measure the severity of Parkinson's disease. Evaluations often fail to consider the health-related quality of life (HrQoL) or apply disease-specific instruments. Health-economic studies normally use estimates of utilities to calculate quality-adjusted life years. We aimed to develop an estimation algorithm for EuroQol- 5 dimensions (EQ-5D)-based utilities from clinical (UPDRS) or disease-specific HrQoL data in the absence of original utilities estimates. METHODS: Linear and fractional polynomial regression analyses were performed with data from a study of Parkinson's disease patients (n=138) to predict the EQ-5D index values from UPDRS and Parkinson's disease questionnaire eight dimensions (PDQ-8) data. German and European weights were used to calculate the EQ-5D index. The models were compared by R2, the root mean square error (RMS), the Bayesian information criterion, and Pregibon's link test. Three independent data sets validated the models. RESULTS: The regression analyses resulted in a single best prediction model (R2: 0.713 and 0.684, RMS: 0.139 and 13.78 for indices with German and European weights, respectively) consisting of UPDRS subscores II, III, IVa-c as predictors. When the PDQ-8 items were utilised as independent variables, the model resulted in an R2 of 0.60 and 0.67. The independent data confirmed the prediction models. CONCLUSION: The best results were obtained from a model consisting of UPDRS subscores II/III/IV a-c. Although a good model fit was observed, primary EQ-5D data are always preferable. Further validation of the prediction algorithm within large, independent studies is necessary prior to its generalised use.
Health and Quality of Life Outcomes 03/2013; 11(1):35. · 2.11 Impact Factor
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Hajo M Hamer,
Richard Dodel,
Adam Strzelczyk, Monika Balzer-Geldsetzer,
Jens-Peter Reese,
Oliver Schöffski,
Wolfgang Graf,
Stefan Schwab,
Susanne Knake,
Wolfgang H Oertel,
Felix Rosenow,
Karel Kostev
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ABSTRACT: Nationwide analyses of drug use can provide a prevalence estimate of the underlying disease and can help in understanding the characteristics of treatment. This study aimed for such analyses regarding the utilization of antiepileptic drugs (AED) for epilepsy in Germany. In 2009, all 4,115,705 AED prescriptions of all German patients with statutory health insurance (70,011,508 persons) were retrospectively analyzed. The IMS(®) LRx database served as data source, which accesses nationwide pharmacy data centers processing all German prescription data. To establish the age and sex-specific percentage of patients taking AED because of epilepsy, we used a second database, Disease Analyzer(®), which covered a representative sample of the German population (7.2 million patients) and contained ICD10 codes alongside with prescription data. The period prevalence of patients taking AED because of epilepsy was 9.1/1,000 (children/adolescents: 5.2/1,000; elderly: 12.5/1,000). Of the patients, 83.1 % took at least one of four AED: valproate (29.8 %), carbamazepine (26.4 %), lamotrigine (21.4 %), and levetiracetam (16.9 %). Oxcarbazepine and sultiame were popular with pediatricians. Elderly patients frequently received phenytoin and primidone. More than half of the patients were treated by family physicians; 68 % took AED in monotherapy and 7.9 % received >2 AED (children/adolescents: 12.5 %). The costs for AED prescribed for epilepsy amounted to 285.1 Mio (median AED costs/patient: 158/a). The German 2009 prevalence of epileptic patients taking AED was 9.1/1,000. Family physicians cared for the majority of patients. Prevalence and prescribing patterns changed with age. Costs of AED against epilepsy added up to 1 % of total medication costs in Germany.
Journal of Neurology 04/2012; · 3.47 Impact Factor
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[show abstract]
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ABSTRACT: We evaluated the health economic burden of patients with Gilles de la Tourette’s syndrome (GTS) in Germany over a 3-month
observation period. Direct and indirect costs were evaluated in 200 outpatients with GTS (mean age 35±11.5years) in Germany.
Patients were recruited from three outpatient departments that specialized in GTS and completed a semi-structured and self-rating
interview with questionnaires screening for direct and indirect medical and non-medical costs, health status, depression,
amount and severity of symptoms. Costs were obtained from various German medical economic resources. Indirect costs for lost
productivity were calculated using the human capital approach. Costs were calculated from the point of view of healthcare
and transfer payment providers and the individual patient. Multivariate regression analyses were performed to identify independent
cost predictors. Costs are in year 2006–2007 values. Direct costs were 620±1,697.1€, including rehabilitation 98.8±993.6€,
hospitalization 195.8±1,267.8€, outpatient treatment 14.0±40.6€, ancillary treatment 51.9±137.4€. Drug costs were 223.1±430.4.
The indirect medical costs amounted to 2,511.3±3,809.5€ for productivity loss and to 220.0±1,092€ for absenteeism. The
following variables were found to impact on direct costs: employment status, occupational advancement, depression, quality
of life, age. Disease severity had no influence on cost. Because of the earlier age of disease onset, indirect costs are higher
than direct costs. Interestingly, disease severity did not influence the resource need in this population. Unfortunately,
no cost of illness studies are available for comparison. Further health economic studies, especially cost-effectiveness studies,
are necessary for a basis for rational resource allocation.
KeywordsTourette-Cost-Quality of life-Economic-Health status
Journal of Neurology 04/2012; 257(7):1055-1061. · 3.47 Impact Factor
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ABSTRACT: INTRODUCTION: Parkinson's disease (PD) is one of the most common neurodegenerative diseases. In the later (advanced) stages of PD, the initial treatment of early PD becomes less effective and long-term side effects of dopaminergic treatment become apparent. In advanced PD, motor and non-motor complications occur, which increase treatment costs. Increasing disability and impaired activities of daily living concomitantly raise indirect costs, due to loss in productivity. Hence, the economic burden of advanced PD is substantial for both the society and the patients with their caregivers. AREAS COVERED: A systematic literature search was performed involving the databases NHS CRD (National Health Service Centre for Reviews and Dissemination) and PubMed until July 15, 2011. "Parkinson" [Mesh] and "cost" were used as search terms in PubMed and only "Parkinson" in the CRD database. EXPERT OPINION: Economic evaluations are scarce and heterogeneous, and their interpretation may be limited due to methodological shortcomings. Dopamine agonists, COMT and MAO-B inhibitors as well levodopa infusion and deep brain stimulation are reported to be cost-effective in the respective decision frameworks. However, these results are heavily dependent on assumptions of drug costs and effect sizes used in the models. More detailed real-life information from long-term clinical trials is needed to feed the economic models, especially for head-to-head comparisons. To date, no economic evaluation has been undertaken for possible neuroprotective/disease modifying effects, and further research is needed for evaluations of interventions for non-motor symptoms.
Expert Opinion on Pharmacotherapy 04/2012; 13(7):939-58. · 3.20 Impact Factor
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ABSTRACT: Parkinson's disease (PD) is a chronic neurodegenerative disorder characterized by progressive loss of dopaminergic (DA) neurons of the substantia nigra pars compacta with unknown aetiology. 6-Hydroxydopamine (6-OHDA) treatment of neuronal cells is an established in vivo model for mimicking the effect of oxidative stress found in PD brains. We examined the effects of 6-OHDA treatment on human neuroblastoma cells (SH-SY5Y) and primary mesencephalic cultures. Using a reverse arbitrarily primed polymerase chain reaction (RAP-PCR) approach we generated reproducible genetic fingerprints of differential expression levels in cell cultures treated with 6-OHDA. Of the resulting sequences, 23 showed considerable homology to known human coding sequences. The results of the RAP-PCR were validated by reverse transcription PCR, real-time PCR and, for selected genes, by Western blot analysis and immunofluorescence. In four cases, [tomoregulin-1 (TMEFF-1), collapsin response mediator protein 1 (CRMP-1), neurexin-1, and phosphoribosylaminoimidazole synthetase (GART)], a down-regulation of mRNA and protein levels was detected. Further studies will be necessary on the physiological role of the identified proteins and their impact on pathways leading to neurodegeneration in PD.
Neuroscience Letters 12/2011; 507(1):10-5. · 2.11 Impact Factor
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ABSTRACT: To estimate costs of multiple sclerosis (MS) in a German cohort according to severity of the disease and clinical symptoms.
144 patients were recruited from an MS outpatient clinic. Costs were calculated according to current German health-economic guidelines from the perspective of the social health insurance system. Patients were either interviewed or completed a questionnaire. Cost assessment covered a 3-month period. Health outcomes were: Expanded Disability Status Scale, MS Functional Composite, Functional Assessment of MS, fatigue, depression (Beck Depression Inventory II) and patients' socioeconomic status. Multivariate linear regression identified independent cost predictors.
Total quarterly costs per patient were EUR 10,329 (95% CI 9,357-11,390). Direct costs were EUR 5,344 for the social health insurance system and EUR 140 for the patient. Drugs represented the major share of direct costs (and 35% of total costs); indirect costs accounted for 47% of total costs. Univariate and multivariate analyses identified age, disability, fatigue and depression as independent predictors for total, indirect or drug costs.
MS represents a high economic burden, with direct costs exceeding indirect costs. To reduce costs, research should focus on prevention that slows down progression of MS. Rehabilitation and symptomatic treatment may have merits in decreasing indirect costs.
European Neurology 11/2011; 66(6):311-21. · 1.81 Impact Factor
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Monika Balzer-Geldsetzer,
Ana Sofia Ferreira Braga da Costa,
Martin Kronenbürger,
Jörg B Schulz,
Sandra Röske,
Annika Spottke,
Ullrich Wüllner,
Thomas Klockgether,
Alexander Storch,
Christine Schneider, [......],
Brit Mollenhauer,
Claudia Trenkwalder,
Inga Liepelt-Scarfone,
Susanne Gräber-Sultan,
Daniela Berg,
Thomas Gasser,
Elke Kalbe,
Maren Bodden,
Wolfgang H Oertel,
Richard Dodel
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ABSTRACT: Parkinson's disease (PD) is a progressive neurodegenerative motor disorder. However, non-motor complications frequently alter the course of the disease. A particularly disabling non-motor symptom is dementia.
The study is designed as a multicentre prospective, observational cohort study of about 700 PD patients aged 45-80 years with or without dementia and PD-mild cognitive impairment (MCI). The patients will be recruited in eight specialized movement disorder clinics and will be followed for 36 months. Information about the patients' functional status will be assessed at baseline and 6-/12- month intervals. In addition, 120 patients with dementia with Lewy bodies (DLB) will be included. Well-established standardized questionnaires/tests will be applied for detailed neuropsychological assessment. In addition, patients will be asked to participate in modules including volumetric MRI, genetic parameters, and neuropsychology to detect risk factors, early diagnostic biomarkers and predictors for dementia in PD.
The study included 604 PD patients by March 2011; 56.3% were classified as having PD alone, with 30.6% of patients suffering from PD-MCI and 13.1% from PD with dementia. The mean age of the cohort was 68.6 ± 7.9 years, with a mean disease duration of 6.8 ± 5.4 years. There was a preponderance of patients in the earlier Hoehn and Yahr stages.
The main aim of the study is to characterize the natural progression of cognitive impairment in PD and to identify factors which contribute to the evolution and/or progression of the cognitive impairment. To accomplish this aim we established a large cohort of PD patients without cognitive dysfunction, PD patients with MCI, and PD patients with dementia, to characterize these patients in a standardized manner, using imaging (serial structural MRI), genetic and proteomic methods in order to improve our understanding of the course of the PD process and the development of cognitive dysfunction and dementia in this disease. The inclusion of the DLB patients will start in the second quarter of 2011 in the BMBF-funded follow-up project LANDSCAPE.
Neuroepidemiology 11/2011; 37(3-4):168-76. · 2.31 Impact Factor
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Jens Peter Reese,
Philipp Hessmann,
Greta Seeberg,
Dajana Henkel,
Pamela Hirzmann,
Jürgen Rieke,
Erika Baum,
Frank Dannhoff,
Matthias J Müller,
Frank Jessen, Monika-Balzer Geldsetzer,
Richard Dodel
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ABSTRACT: The study aims to report service use and costs for patients with Alzheimer's disease (AD) and to explore the incremental influence of sociodemographic and illness-related determinants in ambulatory and inpatient settings within the German health care system. 395 patients with dementia were recruited at the following sites: 1) University hospital, 2) general practitioners' offices, 3) office-based neurologists, 4) a regional psychiatric hospital, and 5) nursing homes. Sociodemographic, economic, and clinical parameters were assessed using a standardized questionnaire. Informal care was not evaluated. Disease severity was measured using the Mini-Mental Status Examination and the Alzheimer's Disease Assessment Scale - Cognitive Subscale. Neuropsychiatric status was assessed using the Geriatric Depression Scale, the Neuropsychiatric Inventory, and the Alzheimer's Disease Cooperative-Study-Activities of Daily Living. Annual total costs were estimated to be €13,080 per patient. The most important cost component was (long-term) care, constituting about 43% of total costs. Indirect costs comprised about 18% of total costs and were mainly due to reductions in working time of caregivers. Poorer functional status was associated with higher total and caregiving costs. In multivariate analyses, we identified younger age, female gender, and impaired activities of daily living as independent predictors of higher costs. Given that care for patients with AD is complex and expensive, our models were only able to explain about 17-43% of the variability in total costs. This suggests that further social and individual factors considerably influence the costs associated with AD. Direct medical care costs and long-term care costs related differently to the patient's clinical characteristics. Longitudinal and population-based studies are necessary for thoroughly evaluating the burden of disease.
Journal of Alzheimer's disease: JAD 08/2011; 27(4):723-36. · 3.74 Impact Factor
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ABSTRACT: Amyloid-β (Aβ) oligomer toxicity is a crucial factor in the development of Alzheimer's disease. Therefore, the aim of therapeutic research is to target the modification of secretase activity, increase Aβ degradation, reduce Aβ formation, and modulate Aβ-induced neuroinflammation. Recently, the p38 MAP kinase inhibitor CNI-1493 has been shown to reduce plaque load and has led to an improvement in memory performance in a transgenic mouse model. We examined the role of CNI-1493 in the microglial inflammatory response to Aβ using both a microglia cell line as well as primary microglia isolated from mesocortices. MTT assays were performed to quantify cell viability. FACS analysis was used to measure phagocytosis. We used ELISA to analyse cytokine concentrations in response to CNI-1493 treatment. Western-blot/Dot-blot techniques were used to show the interaction of CNI-1493 with Aβ-oligomers as well as to measure apoptosis in microglia cells. RT-PCR was used to analyze secretase expression, and secretase function was determined using fluorimetric assays. CNI-1493 is able to prevent oligomer formation as well as apoptosis in microglia. A significant reduction was found in the Aβ-induced release of IL-6 and TNF-α in the presence of CNI-1493. Phagocytosis is an essential Aβ removal mechanism and was enhanced by CNI-1493 in primary microglia. CNI-1493 also influenced the α-secretase product C83 with an increase in the treated cells, while a simultaneous reduction in Aβ secretion was also observed. We hypothesize that CNI-1493 not only reduces neuroinflammation and consequent neurodegeneration, but also leads to a shift in AβPP-processing towards the non-amyloidogenic pathway. Therefore, CNI-1493 is a promising candidate for the treatment of AD.
Journal of Alzheimer's disease: JAD 05/2011; 26(1):69-80. · 3.74 Impact Factor
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Richard Dodel,
Karthikeyan Balakrishnan,
Kathy Keyvani,
Oliver Deuster,
Frauke Neff,
Luminita-Cornelia Andrei-Selmer,
Stephan Röskam,
Carsten Stüer,
Yousef Al-Abed,
Carmen Noelker, Monika Balzer-Geldsetzer,
Wolfgang Oertel,
Yansheng Du,
Michael Bacher
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ABSTRACT: Alzheimer's disease (AD) is a neurodegenerative disorder primarily affecting regions of the brain responsible for higher cognitive functions. Immunization against β-amyloid (Aβ) in animal models of AD has been shown to be effective on the molecular level but also on the behavioral level. Recently, we reported naturally occurring autoantibodies against Aβ (NAbs-Aβ) being reduced in Alzheimer's disease patients. Here, we further investigated their physiological role: in epitope mapping studies, NAbs-Aβ recognized the mid-/C-terminal end of Aβ and preferentially bound to oligomers but failed to bind to monomers/fibrils. NAbs-Aβ were able to interfere with Aβ peptide toxicity, but NAbs-Aβ did not readily clear senile plaques although early fleecy-like plaques were reduced. Administration of NAbs-Aβ in transgenic mice improved the object location memory significantly, almost reaching performance levels of wild-type control mice. These findings suggest a novel physiological mechanism involving NAbs-Aβ to dispose of proteins or peptides that are prone to forming toxic aggregates.
Journal of Neuroscience 04/2011; 31(15):5847-54. · 7.11 Impact Factor
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Richard Dodel,
Karthikeyan Balakrishnan,
Kathy Keyvani,
Oliver Deuster,
Frauke Neff,
Luminita-Cornelia Andrei-Selmer,
Stephan Röskam,
Carsten Stüer,
Yousef Al-Abed,
Carmen Noelker, Monika Balzer-Geldsetzer,
Wolfgang Oertel,
Yansheng Du,
Michael Bacher
[show abstract]
[hide abstract]
ABSTRACT: Alzheimer's disease (AD) is a neurodegenerative disorder primarily affecting regions of the brain responsible for higher cognitive functions. Immunization against -amyloid (A) in animal models of AD has been shown to be effective on the molecular level but also on the behavioral level. Recently, we reported naturally occurring autoantibodies against A (NAbs–A) being reduced in Alzheimer's disease patients. Here, we further investigated their physiological role: in epitope mapping studies, NAbs–A recognized the mid-/C-terminal end of A and preferentially bound to oligomers but failed to bind to monomers/fibrils. NAbs–A were able to interfere with A peptide toxicity, but NAbs–A did not readily clear senile plaques although early fleecy-like plaques were reduced. Administration of NAbs–A in transgenic mice improved the object location memory significantly, almost reaching performance levels of wild-type control mice. These findings suggest a novel physiological mechanism involving NAbs–A to dispose of proteins or peptides that are prone to forming toxic aggregates.
Journal of Neuroscience 12/2010; 31(15):5847-5854. · 7.11 Impact Factor
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Sonja von Campenhausen,
Yaroslav Winter,
Antonio Rodrigues e Silva,
Christina Sampaio,
Evzen Ruzicka,
Paolo Barone,
Werner Poewe,
Alla Guekht,
Céu Mateus,
Karl-P Pfeiffer,
Karin Berger,
Jana Skoupa,
Kai Bötzel,
Sabine Geiger-Gritsch,
Uwe Siebert, Monika Balzer-Geldsetzer,
Wolfgang H Oertel,
Richard Dodel,
Jens P Reese
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ABSTRACT: 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 and price differences. However, inpatient care, long-term care and medication were identified as the major expenditures in the investigated countries.
European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 10/2010; 21(2):180-91. · 3.68 Impact Factor
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ABSTRACT: In 1912, Fritz Heinrich Lewy described neuronal inclusions in the brain of patients who had suffered from Paralysis agitans (i.e., Parkinson's disease). Later, these findings became the so-called "Lewy bodies." However, little is known about the man who made this discovery. Our aim was to investigate Lewy's private and professional life and to gather information for a detailed biography. We contacted over 100 archives, libraries, and museums in Germany, Poland, Switzerland, United Kingdom, and United States. Over 300 documents, publications, and photos were collected. Lewy was born in Berlin, Germany in 1885 and lived there until 1933. After his dismissal on racial grounds by the Nazis, Lewy emigrated to England in 1933 and to the United States of America in 1934, where he lived and worked until his death in 1950. This article gives a summary of Lewy's life and briefly presents his contribution to German and American neurology.
Movement Disorders 09/2010; 25(12):1765-73. · 4.51 Impact Factor
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ABSTRACT: Chromatofocusing was performed in order to separate a polyclonal antigen-specific mixture of human immunoglobulins (IgGs) that would then allow for further analyses of as few different IgGs as possible. Because polyclonal IgGs only differ by amino acid sequence and possible post-translational modifications but not by molecular weight, we chose chromatofocusing for protein separation by different isoelectric points. We isolated antigen-specific IgGs from commercially available intravenous immunoglobulins (IVIG) using a combination of affinity- and size exclusion-chromatography and in order to reduce the complexity of the starting material IVIG was then replaced by single-donor plasmapheresis material. Using two-dimensional gel electrophoresis (2-DE), we observed a clear decrease in the number of different light and heavy chains in the chromatofocusing peak as compared to the starting material. In parallel, we monitored slight problems with the selected peak in isoelectric focusing as the first dimension of 2-DE, displayed in by the less proper focusing of the spots. When we tested whether IgGs were binding to their specific antigen after chromatofocusing, we were able to show that they were still in native conformation. In conclusion, we showed that chromatofocusing can be used as a first step in the analysis of mixtures of very similar proteins, e.g. polyclonal IgG preparations, in order to minimize the amount of different proteins in separated fractions in a reproducible way.
Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 08/2010; 878(24):2249-54. · 2.78 Impact Factor
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ABSTRACT: The prevalence of Parkinson's disease (PD) and costs of healthcare resources for this disease have been increasing in recent years. The objective was to determine the trends in the resource utilization for PD in Germany.
We compared resource utilization in two cohorts of PD patients recruited in 2000 (n=145) and 2004 (n=133) from two clinical departments, two office-based neurologists and several general practitioners. Direct and indirect costs were assessed based on a patient diary and structured personal interviews. Clinical status was classified in Hoehn and Yahr (HY) stages. Cost-driving factors were determined using multivariate regression analysis.
In 2004, total annual costs for PD ranged from EUR 18,660 for HY I-II to EUR 31,660 for HY II-V. As compared to costs in 2000, total costs increased in 2004 by 25-31%. Drug costs increased by 14-20% during this time. The largest increase in direct costs was observed in the early disease (HY I-II), primarily due to rising costs for inpatient care and drugs. Motor complications, age, HY stage and study year were independent cost-driving factors.
The resource utilization in PD increased rapidly over the four year study period. Increasing consumption of healthcare resources due to medical progress is a major factor of rising costs. Future studies should attend more to trends in the utilization of healthcare resources and identify factors which could slow down the expanding costs of healthcare.
Journal of the neurological sciences 07/2010; 294(1-2):18-22. · 2.32 Impact Factor
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ABSTRACT: To investigate the health-related quality of life (HrQoL) of adult patients with Gilles de la Tourette's syndrome (GTS) in Germany. HrQoL was evaluated in 200 adult patients with GTS (Mean age: 34.9 +/- 11.8 years). Patients were recruited from three outpatient departments in Germany and completed a semi-structured, self-rating interview. HrQoL was measured using the EQ-5D. Depression was assessed using the Beck's depression inventory (BDI) and clinical symptoms using the Yale Tourette syndrome symptom list (TSSL) and the Shapiro Tourette-syndrome severity scale (STSSS). Multivariate regression analyses were performed to identify independent predictors of HrQoL. Patients with GTS proved to have a worse HrQoL than a sample from the general German population. The domains most affected were anxiety/depression (57.1%), followed by pain/discomfort (47.5%), usual activities (38.4%), mobility (14%), and self-care (6.6%). The mean EQ-5D visual analog scale (EQ-VAS) was 65.4 +/- 21.9. The patients had a mean BDI score of 12.3 +/- 9.9, which was considerably worse compared to a healthy group who had a score of 6.45 +/- 5.2. The mean STSSS value was 3.2 +/- 1.1. In multivariate analyses, depressive symptoms contributed considerably, whereas the severity of symptoms as well as age only contributed minimally to HrQoL in the model (R(2) = 0.54). HrQoL is considerably reduced in adult patients with GTS. The main independent factors for determining HrQoL were depression, severity of symptoms, and age. Although, treatment of tics is important, co-morbidities such as depression should be diagnosed and treated vigorously.
Movement Disorders 02/2010; 25(3):309-14. · 4.51 Impact Factor
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ABSTRACT: Copper deficiency has been described as resulting in severe neurological impairment. However, mechanisms underlying a copper deficiency are presently unknown.
We describe three patients suffering from severe spasticity, ataxia and hyperreflexia and had laboratory evidence of copper deficiency.
Genetic analysis of six copper transporters/chaperones revealed no mutations, but two SNPs in one copper transporter protein and one copper chaperone.
Owing to the severity of the disease further research is required to elucidate the mechanisms leading to copper deficiency.
Journal of the neurological sciences 02/2010; 291(1-2):95-7. · 2.32 Impact Factor
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ABSTRACT: We evaluated the health economic burden of patients with Gilles de la Tourette's syndrome (GTS) in Germany over a 3-month observation period. Direct and indirect costs were evaluated in 200 outpatients with GTS (mean age 35 +/- 11.5 years) in Germany. Patients were recruited from three outpatient departments that specialized in GTS and completed a semi-structured and self-rating interview with questionnaires screening for direct and indirect medical and non-medical costs, health status, depression, amount and severity of symptoms. Costs were obtained from various German medical economic resources. Indirect costs for lost productivity were calculated using the human capital approach. Costs were calculated from the point of view of healthcare and transfer payment providers and the individual patient. Multivariate regression analyses were performed to identify independent cost predictors. Costs are in year 2006-2007 values. Direct costs were 620 +/- 1,697.1euro, including rehabilitation 98.8 +/- 993.6euro, hospitalization 195.8 +/- 1,267.8euro, outpatient treatment 14.0 +/- 40.6euro, ancillary treatment 51.9 +/- 137.4euro. Drug costs were 223.1 +/- 430.4. The indirect medical costs amounted to 2,511.3 +/- 3,809.5euro for productivity loss and to 220.0 +/- 1,092euro for absenteeism. The following variables were found to impact on direct costs: employment status, occupational advancement, depression, quality of life, age. Disease severity had no influence on cost. Because of the earlier age of disease onset, indirect costs are higher than direct costs. Interestingly, disease severity did not influence the resource need in this population. Unfortunately, no cost of illness studies are available for comparison. Further health economic studies, especially cost-effectiveness studies, are necessary for a basis for rational resource allocation.
Journal of Neurology 02/2010; 257(7):1055-61. · 3.47 Impact Factor
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Bernhard Meyer,
Florian Ringel,
Yaroslav Winter,
Annika Spottke,
Nadir Gharevi,
Judith Dams, Monika Balzer-Geldsetzer,
Ines K Mueller,
Thomas Klockgether,
Johannes Schramm,
Horst Urbach,
Richard Dodel
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ABSTRACT: Aneurysmal subarachnoid haemorrhage (SAH) is a devastating disease with high mortality and disability. The data from large longitudinal studies on health-related quality of life (HRQoL) in patients with SAH are limited. The objective was to investigate HRQoL in patients after SAH and to identify predictors of HRQoL.
113 patients with aneurysmal SAH were assigned to either neurosurgery (n = 57) or endovascular coiling (n = 56). Clinical assessments (Barthel Index, modified Rankin Scale) and evaluation of HRQoL [36-Item Short-Form Survey, EuroQol (EQ5D), EQ visual analogue scale (EQ VAS)] were performed at discharge, and at 6 and 12 months of follow-up. Independent predictors of HRQoL were determined using multiple regression analysis.
HRQoL in SAH patients was considerably reduced compared to the normal population. At discharge, 92.2% of the patients had moderate or severe problems on the EQ5D. The EQ VAS score was 57.8 +/- 19.3. However, HRQoL still showed improvement from 3 months up to 1 year. At 12 months after SAH, the EQ VAS score was approximately 12-14% higher than at discharge. The independent predictors of decreased HRQoL included female gender, severe SAH, functional disability, depression, a lower level of education and the lack of a stable partnership.
The long-term HRQoL outcome after SAH is unfavourable. HRQoL outcome measures should be included in future studies to provide better evidence of the long-term outcomes after SAH. In addition, the independent determinants of HRQoL identified in this study should be considered in the healthcare programmes aimed at increasing the HRQoL in SAH survivors.
Cerebrovascular Diseases 01/2010; 30(4):423-31. · 2.72 Impact Factor
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Yaroslav Winter,
Sonja von Campenhausen,
Jens P Reese, Monika Balzer-Geldsetzer,
Katia Longo,
Giuseppe Spiga,
Kai Boetzel,
Karla Eggert,
Wolfgang H Oertel,
Richard Dodel,
Paolo Barone
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ABSTRACT: Antiparkinsonian pharmacotherapy is costly and the determinants of drug costs in Parkinson's disease (PD) have been poorly investigated. The objective of this study was to investigate the costs of PD and antiparkinsonian drugs in an Italian cohort of patients and identify cost-driving factors of drug therapy.
Seventy outpatients with idiopathic PD were recruited in the Department of Neurology, Napoli University, Italy. Data on resource utilization were collected for 6 months using a bottom-up approach. Clinical status was evaluated using the Unified Parkinson's Disease Rating Scale. Direct and indirect costs were calculated from the societal perspective (figures of year 2009). Independent determinants of total costs and costs of antiparkinsonian drugs were identified using multivariate regression analysis.
The total costs of PD were EUR 8,640 (95% CI: EUR 6,700-11,240) per patient over a 6-month period. Direct costs accounted for 70% of the total costs. Antiparkinsonian drugs (EUR 1,450; 95% CI: EUR 1,220-1,760) were the primary component of costs paid by the health insurance (39.6%) and one of the most expensive components of the direct costs (24.0%). The highest copayments made by patients were for antiparkinsonian drugs and medical equipment (58%). Independent determinants of the increased costs of antiparkinsonian pharmacotherapy were younger age and occurrence of motor fluctuations.
Antiparkinsonian pharmacotherapy is one of the major cost components of PD-related costs for health insurance. It imposes a considerable economic burden on patients and their families as well.
Neurodegenerative Diseases 01/2010; 7(6):365-72. · 3.06 Impact Factor
