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Economic burden associated with Parkinson Disease

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... PD increases economic burden more than previously understood and affects PWPs, care partners, employers, payers, and society at large. Our estimated prevalence, annual direct medical costs, and indirect and non-medical costs are significantly higher than several previous U.S. based studies assessing the economic burden of PD (Table 3) 8,11,12 . Our prevalence estimates are comparable to the more recent estimates of Marras et al. 1 . ...
... The Huse et al. analysis is the most comparable to our study as they also mainly used claims data for direct costs (1999-2002 MarketScan claims database) and a regression-based approach to estimate the cost increase due to PD 12 . O'Brien used a cost modeling approach to estimate the direct medical cost of PD using healthcare encounter data (e.g., inpatient admission, emergency room visit) representing limited geographic areas 11 . The Noyes et al. study was conducted a decade prior to our study and adjusted for demographic factors and comorbidities (e.g., cardiovascular, psychiatric, stroke, etc.) 14 . ...
... Although patient selfreported survey outcomes are subject to potential selection bias or recall bias, the large sample size likely mitigates some of these issues. Other studies included fewer cost components that were available in secondary data sources such as national surveys 8,12 or relied on smaller PD-specific surveys 6,11 . ...
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Parkinson’s disease (PD) is one of the world’s fastest growing neurological disorders. Much is unknown about PD-associated economic burdens in the United States (U.S.) and other high-income nations. This study provides a comprehensive analysis of the economic burdens of PD in the U.S. (2017) and projections for the next two decades. Multiple data sources were used to estimate the costs of PD, including public and private administrative claims data, Medicare Current Beneficiary Survey, Medical Expenditure Panel Survey, and a primary survey (n = 4,548) designed for this study. We estimated a U.S. prevalence of approximately one million individuals with diagnosed Parkinson’s disease in 2017 and a total economic burden of $51.9 billion. The total burden of PD includes direct medical costs of $25.4 billion and $26.5 billion in indirect and non-medical costs, including an indirect cost of $14.2 billion (PWP and caregiver burden combined), non-medical costs of $7.5 billion, and $4.8 billion due to disability income received by PWPs. The Medicare program bears the largest share of excess medical costs, as most PD patients are over age 65. Projected PD prevalence will be more than 1.6 million with projected total economic burden surpassing $79 billion by 2037. The economic burden of PD was previously underestimated. Our findings underscore the substantial burden of PD to society, payers, patients, and caregivers. Interventions to reduce PD incidence, delay disease progression, and alleviate symptom burden may reduce the future economic burden of PD.
... This chapter also describ es our results supporting possible deficits in respons e generatio n as observed in th e funct ional MRI study. (Chen, 2010;O'Brien et al., 2009) . Dependent up on the age of the patient at diseas e onset, PD is classified as either juvenile -onset PD (<20years), early -onset PD (<50 years), or late-onset PD (>50 years). ...
... Taken together, our observations indicate that, the model of pre -motor stage PD developed during this research is a very high face validity rat model of late Braak stage 2 or early Braak stage 3 PD. Sodium butyrate was able to alleviat e the cognitive deficits obs erved in our rat model.Hence, alo ng with the prior reports of anti -depressant and neuroprotective effects of this drug, our results point towards a possible treatment strat egy for the non -motor deficits of PD.the Unit ed Stat es(Chen, 201 0;O'Brien et al., 2009) . This cost includes, not just the cost of treatment of this disease, but also the cost of the disabilit y that fo llows it. ...
... Its accurate diagnosis is challenging and misdiagnosis is common. [1][2][3] Additionally, overdiagnosis of PD has been observed when only clinical symptoms were used to assess uncertain cases. 4 Although experts in movement disorders are able to achieve greater diagnostic accuracy than their primary care or general neurology counterparts, they are still uncertain about the diagnosis in many patients. ...
... When assessing the utility of DaTscan imaging, it is important to note the clinical benefits that imaging with DaTscan may offer for a disease that is, in many cases, challenging to diagnose. 2 DaTscan imaging has been shown to confer more accurate diagnoses, resulting in frequent diagnostic and therapeutic revisions for patients with suspected PD, and major clinical guidelines recommend DaTscan imaging. 12,14,25,37,38 An earlier and more accurate diagnosis of PD may have substantial benefits. ...
Article
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Parkinson’s disease (PD), the second-most common neurodegenerative disease, is characterized by motor and nonmotor symptoms. PD is often misdiagnosed; inappropriate treatment due to misdiagnosis has undesired consequences, as does delayed diagnosis. Unfortunately, most people with PD receive a diagnosis only after motor symptoms have emerged, by which time 40% to 60% of dopamine neurons have already been lost. Advances in imaging techniques have provided clinicians with increasingly sophisticated tools. In 2011, the US Food and Drug Administration approved ioflupane I-123 injection (DaTscanTM) for striatal dopamine transporter visualization using single-photon emission computed tomography (SPECT) imaging, which provides an effective tool for assessing striatal dopaminergic deficiency. Among patients with suspected parkinsonian syndromes, of which PD is one, the diagnostic sensitivity and specificity of DaTscan SPECT imaging are high. In clinical studies that were part of the DaTscan new drug application, no serious drugrelated adverse events reported by the 1236 participants were attributed to DaTscan. The introduction of DaTscan imaging and its utility necessitate the development of clinical recommendations for appropriate use; thus, a multidisciplinary panel of experts was convened to develop clinical criteria and algorithms to help guide clinicians and managed care organizations in the application of DaTscan SPECT imaging. Based on the consensus of this expert panel, appropriate use of DaTscan SPECT imaging includes cases where: (1) PD diagnosis is uncertain; (2) tremor of uncertain etiology is present; and (3) nonmotor and/ or supportive symptoms and features associated with PD are present but the classical motor syndrome is absent or atypical.
... With an ever-increasing number of patients suffering with Parkinson's disease (PD) worldwide, as the average age of the population rises [1,2], the cost of medical and pharmaceutical treatments for these afflicted individuals is climbing rapidly [3][4][5][6][7][8]. A recent estimate of the annual economic impact associated with PD in the United States (US) alone approaches $11 billion, with over half of the expense related to direct medical costs [9]. With the number of individuals suffering from PD in the US today expected to double by 2030 [10], cost-effective approaches to treatment and possible disease-modifying therapies are being aggressively pursued. ...
Article
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The pharmaceutical industry's development of therapeutic medications for the treatment of Parkinson's disease (PD) endures, as a result of the continuing need for better agents, and the increased clinical demand due to the aging population. Each new drug offers advantages and disadvantages to patients when compared to other medical offerings or surgical options. Deep brain stimulation (DBS) has become a standard surgical remedy for the effective treatment of select patients with PD, for whom most drug regimens have failed or become refractory. Similar to DBS as a surgical option, gene therapy for the treatment of PD is evolving as a future option. In the four different PD gene therapy approaches that have reached clinical trials investigators have documented an excellent safety profile associated with the stereotactic delivery, viral vectors and doses utilized, and transgenes expressed. In this article, we review the clinically relevant gene therapy strategies for the treatment of PD, concentrating on the published preclinical and clinical results, and the likely mechanisms involved. Based on these presentations, we advance an analysis of how the nature of the gene therapy used may eventually expand the scope and utility for the management of PD.
... PD is a devastating degenerative neurological illness without cure affecting approximately 0.3% of the entire population and 1–2% of the population over 60 years (Samii et al., 2004). Overall, the annual economic impact of PD only in the United States is estimated at $10.8 billion, 58% of which is related to direct medical costs (O'Brien et al., 2009). As the incidence of the disease increases with age (the most important risk factor), it is likely that the number of people suffering from PD will rise steadily in the future. ...
Article
Glucose-dependent insulinotropic polypeptide (GIP) is a 42-amino acid hormone, secreted from the enteroendocrine K cells, which has insulin-releasing and extra-pancreatic actions. GIP and its receptor present a widespread distribution in the mammalian brain where they have been implicated with synaptic plasticity, neurogenesis, neuroprotection and behavioral alterations. This review attempts to provide a comprehensive picture of the role of GIP in the central nervous system and to highlight recent findings from our group showing its potential involvement in neurological illnesses including epilepsies, Parkinson's disease and Alzheimer's disease.
... Since the incidence of the disease increases with age (the most important risk factor), it is likely that the number of people suffering from PD will rise steadily in the future. Overall, the annual economic impact of PD only in the United States is estimated at $10.8 billion, 58% of which is related to direct medical costs [3]. ...
Article
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Parkinson's disease (PD) is the second most common neurodegenerative disorder affecting approximately 1% of the population older than 60 years. Classically, PD is considered to be a motor system disease and its diagnosis is based on the presence of a set of cardinal motor signs that are consequence of a pronounced death of dopaminergic neurons in the substantia nigra pars compacta (SNc). Nowadays there is considerable evidence showing that non-dopaminergic degeneration also occurs in other brain areas which seems to be responsible for the deficits in olfactory, emotional and memory functions that precede the classical motor symptoms in PD. Dopamine-replacement therapy has dominated the treatment of PD and although the currently approved antiparkinsonian agents offer effective relief of the motor deficits, they have not been found to alleviate the non-motor features as well as the underlying dopaminergic neuron degeneration and thus drug efficacy is gradually lost. Another major limitation of chronic dopaminergic therapy is the numerous adverse effects such as dyskinesias, psychosis and behavioral disturbance. The development of new therapies in PD depends on the existence of representative animal models to facilitate the evaluation of new pharmacological agents before they are applied in clinical trials. We have recently proposed a new experimental model of PD consisting of a single intranasal (i.n.) administration of the proneurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 1 mg/nostril) in rodents. Our findings demonstrated that rats and mice treated intranasally with MPTP suffer impairments in olfactory, cognitive, emotional and motor functions conceivably analogous to those observed during different stages of PD. Such infusion causes time-dependent loss of tyrosine hydroxylase in the olfactory bulb and SNc, resulting in significant dopamine depletion in different brain areas. We have also identified some pathogenic mechanisms possibly involved in the neurodegeneration induced by i.n. administration of MPTP including mitochondrial dysfunction, oxidative stress, activation of apoptotic cell death mechanisms and glutamatergic excitotoxicity. Therefore, the present review attempts to provide a comprehensive picture of the i.n. MPTP model and to highlight recent findings from our group showing its potential as a valuable rodent model for testing novel drugs that may provide alternative or adjunctive treatment for both motor and non-motor symptoms relief with a reduced side-effect profile as well as the discovery of compounds to modify the course of PD.
... Since the incidence of this disease increases with age (the most important risk factor), the number of people suffering from PD is expected to steadily rise over the next few years. Currently, the annual economic impact of PD in the United States is around $10.8 billion, 58% of which is related to direct medical costs (O'Brien et al. 2003). PD is classically considered a motor system disease with a diagnosis based on a set of cardinal motor signs (e.g., rigidity, bradykinesia, rest tremor, and postural reflex disturbance ) that reflect loss of dopaminergic neurons of the substantia nigra pars compacta (SNpc) (Hirsch et al. 1988; Schapira 2008). ...
Article
The causes of Parkinson's disease (PD) are unknown, but there is evidence that exposure to environmental agents, including a number of viruses, toxins, agricultural chemicals, dietary nutrients, and metals, is associated with its development in some cases. The presence of smell loss and the pathological involvement of the olfactory pathways in the early stages of PD are in accord with the tenants of the olfactory vector hypothesis. This hypothesis postulates that some forms of PD may be caused or catalyzed by environmental agents that enter the brain via the olfactory mucosa. In this article, we provide an overview of evidence implicating xenobiotics agents in the etiology of PD and review animal, mostly rodent, studies in which toxicants have been introduced into the nose in an attempt to induce behavioral or neurochemical changes similar to those seen in PD. The available data suggest that this route of exposure results in highly variable outcomes, depending upon the involved xenobiotic, exposure history, and the age and species of the animals tested. Some compounds, such as rotenone, paraquat, and 6-hydroxydopamine, have limited capacity to reach and damage the nigrostriatal dopaminergic system via the intranasal route. Others, such as 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), readily enter the brain via this route in some species and influence the function of the nigrostriatal pathway. Intranasal infusion of MPTP in some rodents elicits a developmental sequence of behavioral and neurochemical changes that closely mimics that seen in PD. For this reason, such an MPTP rodent model appears to be an ecologically valid means for assessing novel palliative treatments for both the motor and non-motor symptoms of PD. More research is needed, however, on this and other ecologically valid models.
... 24 According to a study from the United States regarding patient burden with medical expenses for the treatment of Parkinson's disease, the mean LOS was 5.3 days. 25 Due to differences in medical systems, the status of geriatric disease, and access to medical institutions between countries, a simple comparison of LOS would not be useful. However, the present study has revealed that LOS in tertiary and general hospitals is longer in Korea than in other countries. ...
Article
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The elderly population and the prevalence of stroke, dementia, and Parkinson's disease are increasing rapidly in Korea. The aim of this study was to establish the length of stay (LOS) for neurological geriatric diseases, and analyze this parameteraccording to healthcare institutions. We used data from the Health Insurance Review and Assessment Service from 2003 to 2007. Nineteen neurological geriatric diseases were classified into four groups: dementia, cerebral hemorrhage, cerebral infarction, and Parkinson's disease. LOS was analyzed according to gender, age, insurance type, disease group, and type of healthcare institution. The LOS for neurological geriatric diseases lengthened from 5,550,193 days (10.8% of the total National Health Insurance admission days) in 2003 to 14,749,671 days (19.7%) in 2007. The mean LOS was 40.8 days in 2003, and lengthened to 71.2 days in 2007. After stratification by disease group, the mean LOS for long-term-care hospitals lengthened by 1.43 times (from 81.7 to 116.6 days) in the cerebral infarction group, 1.35 times (from 85.6 to 115.2 days) in the cerebral hemorrhage group, and 1.28 times (from 82.7 to 105.7 days) in the Parkinson's disease group. The LOS for neurological geriatric diseases has lengthened markedly, which isdue to an increasesin the number of hospitalized patients and the mean LOS, which have increased most rapidly in long-term-care hospitals. These results may be useful in developing geriatric health policies.
... Since the incidence of the disease increases with age (the most important risk factor), it is likely that the number of people suffering from PD will rise steadily in the future. Overall, the annual economic impact of PD in the United States is estimated at $10.8 billion, 58% of which is related to direct medical costs (O'Brien et al., 2003). ...
Article
Parkinson's disease (PD) is the second most common neurodegenerative disorder affecting about 1% of the population older than 60 years. Classically, PD is considered as a movement disorder, and its diagnosis is based on the presence of a set of cardinal motor signs that are the consequence of a pronounced death of dopaminergic neurons in the substantia nigra pars compacta. There is now considerable evidence showing that the neurodegenerative processes leading to sporadic PD begin many years before the appearance of the characteristic motor symptoms, and that additional neuronal fields and neurotransmitter systems are also involved in PD, including olfactory structures, amygdala, caudal raphe nuclei, locus coeruleus, and hippocampus. Accordingly, adrenergic and serotonergic neurons are also lost, which seems to contribute to the anxiety in PD. Non-motor features of PD usually do not respond to dopaminergic medication and probably form the major current challenge in the clinical management of PD. Additionally, most studies performed with animal models of PD have investigated their ability to induce motor alterations associated with advanced phases of PD, and some studies begin to assess non-motor behavioral features of the disease. The present review attempts to examine results obtained from clinical and experimental studies to provide a comprehensive picture of the neurobiology and current and potential treatments for anxiety in PD. The data reviewed here indicate that, despite their high prevalence and impact on the quality of life, anxiety disorders are often under-diagnosed and under-treated in PD patients. Moreover, there are currently few clinical and pre-clinical studies underway to investigate new pharmacological agents for relieving these symptoms, and we hope that this article may inspire clinicians and researchers devote to the studies on anxiety in PD to change this scenario. This article is part of a Special Issue entitled 'Anxiety and Depression'.
... us annual direct costs were estimated at $6.2 billion, with a total expenditure estimate of $11 billion when indirect costs are included. 11 Although these costs are approximately half of the estimated total costs reported by others, this study demonstrates that costs increase significantly when pD patients are transferred to institutional care. ...
Article
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Parkinson's disease (PD) imposes a significant economic burden on the healthcare system. As the population continues to age and shifts to include a larger proportion of persons 65 years and older, the economic burden related to PD will continue to escalate. Clinicians should be mindful of striving for efficiency, making prudent choices, and allocating resources appropriately. The majority of treatment costs in PD are associated with advancing disease; specifically, the costs related to increasing need for care. Early identification of motor and non-motor signs and symptoms of disease allows for earlier treatment. Through early treatment strategies, symptom control is improved and patients will likely have less need for care. This leads to improvements in quality of life (QoL) and functional independence and reduced caregiver burden and thus results in decreased costs. In addition, although research thus far has not clearly demonstrated the ability of an agent to provide disease modification, as new, potentially neuroprotective therapeutic interventions are developed and become available as treatment options, the recognition of early disease will be more important. If earlier treatment with neuroprotective agents leads to slowing of disease progression, the result may be less need for care and decreased costs for patients with PD. This may have a measurable impact by improving QoL measures for both the patient and caregivers.
... Our estimate of $12,800 in annual disease-related medical costs per patient is slightly smaller than that of Huse et al. and O'Brien et al., who, despite using different methods and data sources, report estimates of $14,400 and $13,900 (adjusted to 2010 dollars). 10,14 Our estimated annual costs are slightly higher than the study of the Medicare population conducted by Noyes , which is based on less-conservative assumptions. Our study does not attempt to value services by informal caregivers or any reduction by PD patients in their nonpaid productivity in the home or the community. ...
Article
Parkinson's disease (PD), following Alzheimer's disease, is the second-most common neurodegenerative disorder in the United States. A lack of treatment options for changing the trajectory of disease progression, in combination with an increasing elderly population, portends a rising economic burden on patients and payers. This study combined information from nationally representative surveys to create a burden of PD model. The model estimates disease prevalence, excess healthcare use and medical costs, and nonmedical costs for each demographic group defined by age and sex. Estimated prevalence rates and costs were applied to the U.S. Census Bureau's 2010 to 2050 population data to estimate current and projected burden based on changing demographics. We estimate that approximately 630,000 people in the United States had diagnosed PD in 2010, with diagnosed prevalence likely to double by 2040. The national economic burden of PD exceeds $14.4 billion in 2010 (approximately $22,800 per patient). The population with PD incurred medical expenses of approximately $14 billion in 2010, $8.1 billion higher ($12,800 per capita) than expected for a similar population without PD. Indirect costs (e.g., reduced employment) are conservatively estimated at $6.3 billion (or close to $10,000 per person with PD). The burden of chronic conditions such as PD is projected to grow substantially over the next few decades as the size of the elderly population grows. Such projections give impetus to the need for innovative new treatments to prevent, delay onset, or alleviate symptoms of PD and other similar diseases. © 2013 Movement Disorder Society.
... The drivers identified for this economic burden included outpatient service costs (24 % of the total direct cost), hospitalisation costs (15 % of the total direct cost), and the cost of prescription drugs (14 % of the total direct cost) [13]. Similarly, a recent observational study estimated that the annual cost of PD in the USA was approximately $10.78 billion (2007 US dollars), with direct costs accounting for $6.22 billion and indirect costs accounting for $4.56 billion per year [23]. The variable response to dopamine replacement therapy observed in patients with PD is likely to affect the direct healthcare costs incurred, with higher costs expected in PD populations for whom the medication is less effective, either through lack of efficacy or noncompliance. ...
Article
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Background: Parkinson's disease (PD) is a progressive neurological disorder for which, at present, there is no cure. Current therapy is largely based on the use of dopamine agonists and dopamine replacement therapy, designed to control the signs and symptoms of the disease. The majority of current treatments are administered in tablet form and can involve multiple daily doses, which may contribute to sub-optimal compliance. Previous studies with small groups of patients suggest that non-compliance with treatment can result in poor response to therapy and may ultimately increase direct and indirect healthcare costs. Objective: To determine the extent of non-compliance within the general PD population in the USA as well as the patient characteristics and healthcare costs associated with compliance and non-compliance. Methods: A retrospective analysis from a managed care perspective was conducted using data from the USA PharMetrics patient-centric claims database. PharMetrics claims data were complete from 31 December 2005 to 31 December 2009. Patients were included if they had at least two diagnoses for PD between 31 December 2005 and 31 December 2008, were older than 18 years of age, were continuously enrolled for at least 12 months after the date of the most recent PD diagnosis, and had no missing or invalid data. The follow-up period was the most recent 12-month block of continuous enrollment that occurred between 2006 and 2009. Patients were required to have at least one PD-related prescription within the follow-up period. The medication possession ratio (MPR) was used to categorise patients as compliant or non-compliant. Direct all-cause annual healthcare costs for patients with PD were estimated for each patient, and regression analyses were conducted to determine predictors for non-compliance. Results: A total of 15,846 patients were included, of whom 46 % were considered to be non-compliant with their prescribed medication (MPR <0.8). Predictors of non-compliance included prescription of a medication administered in multiple daily doses (p < 0.0001), a period of <2 years since the initial PD diagnosis (p = 0.0002), a diagnosis of gastrointestinal disorder (p < 0.0001), and a diagnosis of depression (p < 0.0001). Non-compliance was also found to be related to age, with a lower odds of non-compliance in patients aged 41-80 years than in patients aged ≥81 years (p < 0.05). Although total drug mean costs were higher for compliant patients than non-compliant patients (driven mainly by the cost of PD-related medications), the mean costs associated with emergency room and inpatient visits were higher for patients non-compliant with their prescribed medication. Overall, the total all-cause annual healthcare mean cost was lower for compliant ($77,499) than for non-compliant patients ($84,949; p < 0.0001). Conclusion: Non-compliance is prevalent within the general USA PD population and is associated with a recent PD diagnosis, certain comorbidities, and multiple daily treatment dosing. Non-compliance may increase the burden on the healthcare system because of greater resource usage compared with the compliant population. Treatments that require fewer daily doses may have the potential to improve compliance, which in turn could reduce the economic burden associated with PD.
... Although it is difficult to compare costs directly with studies on neuromuscular diseases outside of the U.S. due to differences in healthcare systems and differences in methodology. Our estimated costs of neuromuscular diseases are similar to those reported previously in other countries (Supplemental Table 5 15,16 . Thus, our cost estimates for neuromuscular diseases are comparable to or somewhat higher than those associated with other disabling diseases. ...
Article
Introduction: We conducted a comprehensive study of the costs associated with amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy (DMD). and myotonic dystrophy (DM) in the U.S. Methods: We determined the total impact on the U.S. economy, including direct medical costs, nonmedical costs, and loss of income. Medical costs were calculated using a commercial insurance database and Medicare claims data. Nonmedical and indirect costs were determined through a survey of families registered with the Muscular Dystrophy Association. Results: Medical costs were driven by outpatient care. Nonmedical costs were driven by the necessity to move or adapt housing for the patient and paid caregiving. Loss of income correlated significantly with the amount of care needed by the patient. Conclusions: We calculated the annual per-patient costs to be $63,693 for ALS, $50,952 for DMD, and $32,236 for DM. Population-wide national costs were $1,023 million (ALS), $787 million (DMD), and $448 million (DM).
... We use $100,000 as the value of one QALY gained (V) because Chandra et al.[14]noted that it is the value by which an effective regulation is measured. We use O'Brien et al.'s[15]recent comprehensive assessment of $21,626 for the diverted medical and non-medical costs of PD, which includes $12,491 for the direct medical costs of PD (hospitalization, physician visits, medications and diagnostic tests) and $9135 for indirect costs of PD (lost wages of PD patient, lost wages of PD patient caregiver, personal care aide and death related costs). This estimate is not dissimilar from earlier values[16][17][18]. ...
Article
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Citing a lack of information, the U.S. Environmental Protection Agency prudently did not account for the benefits of averting many chronic diseases in analyzing the Worker Protection Standards (WPS) revisions. We demonstrate that sufficient information can exist, using the example of the benefits to agricultural workers of reduced Parkinson’s disease (PD) due to reduced pesticide exposure. We define the benefits as the monetary value gained by improving quality of lives of people who would otherwise develop PD, plus the value of medical care cost averted and income not lost due to being healthy. For estimation, we use readily available parameters and obtain odds ratios of developing PD by conducting a meta-analysis of studies linking pesticide exposure to PD. The sensitivity analysis varies the number of agricultural workers affected by the regulation, the probability of being diagnosed with PD, the measurement and the timing of the benefits. Our initial assessment is that the reduced PD benefits would be a small fraction of the total WPS revision costs. However, if we define benefits as the common environmental economics willingness to pay to avoid PD incidence, then they become a substantial fraction of the costs. Our analysis demonstrates that the benefits of averting PD from the WPS revisions can be estimated using existing information, and that the results are most sensitive to the choice of valuation of benefits to the worker. We encourage other researchers to extend our framework to other chronic ailments.
... Current socio-economic burden per PD patient per year is estimated to be US$ 24,000. 6 Further, the increase in cost was found to be six times higher for patients in the late stages of PD compared to early stages. 7,8,9 Epidemiological studies have found that Parkinsonism is prevalent to a varying degree in all countries that have been studied to date. ...
... This disease predominantly affects people aged 60 years or older [2]; an estimated 1.6 million Medicare beneficiaries live with PD [3]. PD places substantial economic burden on patients and insurers, and costs society on average $10.8 billion annually [4]. The cost of PD is expected to increase with the aging baby boomers [5,6]. ...
Article
Objectives We examine the associations of adherence to antiparkinson drugs (APDs) with health care utilization and economic outcomes among patients with Parkinson’s disease (PD). Methods By using 2006–2007 Medicare administrative data, we examined 7583 beneficiaries with PD who filled two or more APD prescriptions during 19 months (June 1, 2006, to December 31, 2007) in the Part D program. Two adherence measures— duration of therapy (DOT) and medication possession ratio (MPR)—were assessed. Negative binomial and gamma generalized linear models were used to estimate the rate ratios (RRs) of all-cause health care utilization and expenditures, respectively, conditional upon adherence, adjusting for survival risk, sample selection, and health-seeking behavior. Results Approximately one-fourth of patients with PD had low adherence (MPR < 0.80, 28.7%) or had a short DOT (≤400 days, 23.9%). Increasing adherence to APD therapy was associated with decreased health care utilization and expenditures. For example, compared with patients with low adherence, those with high adherence (MPR = 0.90–1.00) had significantly lower rates of hospitalization (RR = 0.86), emergency room visits (RR = 0.91), skilled nursing facility episodes (RR = 0.67), home health agency episodes (RR = 0.83), physician visits (RR = 0.93), as well as lower total health care expenditures (−$2242), measured over 19 months. Similarly, lower total expenditure (−$6308) was observed in patients with a long DOT versus those with a short DOT. Conclusions In this nationally representative sample, higher adherence to APDs and longer duration of use of APDs were associated with lower all-cause health care utilization and total health care expenditures. Our findings suggest the need for improving medication-taking behaviors among patients with PD to reduce the use of and expenditures for medical resources.
... P arkinson disease (PD) is a neurodegenerative condition that affects more than one million people in the United States (Abrantes et al., 2012). PD typically affects adults older than 60 years, and its incidence is projected to double by the year 2030 because of the growing aging population in the United States (Dorsey et al., 2007;O'Brien, Ward, Michels, Tzivelekis, & Brandt, 2009). The symptoms of PD include both motor and nonmotor symptoms (NMSs). ...
Article
Fatigue, one of the most prevalent and underassessed nonmotor symptoms in patients with Parkinson disease (PD), is reported to be a major cause of disability and reduced quality of life. The purpose of this review was to systematically examine the scientific literature and report how fatigue is defined and measured and what interventions are used to treat it. A synthesis of the current literature will expose the current state of the science of fatigue in PD, propose areas for future research, and offer practice implications. An integrative review of the literature was conducted. The electronic databases CINAHL, Psychinfo, and PUBMED were searched using the keywords "Parkinson's disease," "fatigue," "definition," "mental fatigue," "physical fatigue," "measurement," "interventions," "treatment," and "methylphenidate." One hundred fourteen articles were found. Nineteen studies met review criteria. No universal definition of fatigue in PD was found, making it difficult to measure. However, central, physical, mental, and peripheral fatigues were described. Six scales were found that measure fatigue in PD; only one specific to PD, the Parkinson Fatigue Scale, measured physical fatigue. Seven studies reported interventions to treat fatigue and were categorized as medication, exercise, and alternative interventions. None of these interventions had a significant effect on fatigue. Findings showed that (a) there is a lack of a universally accepted definition of fatigue because of its subjective nature, (b) existing fatigue measurement tools do not measure all types of fatigue in PD, and (c) no intervention had a significant effect on fatigue. There is a need to define and explore fatigue further using qualitative methods. Further development of instruments to measure fatigue in women, younger onset, and older adults with PD is needed. A focus on person-centered interventions to reduce fatigue in patients with PD is a research priority.
... 18 Estimates of annual disease-related medical costs per PD patient range from $10,378 to $14,400 (in 2010 U.S. dollars), not including indirect costs. [19][20][21][22] Our study suggests that previous projections may have underestimated PD prevalence by 10% in the coming decade by not accounting for the impact of decreasing rates of smoking. Even by our conservative estimates, these 70,000 additional PD cases would add an annual cost of greater than $700 million for the United States. ...
Article
Objective: Previous studies have estimated future PD prevalence based on population aging. This study revisits that projection by accounting for the potential impact of declining rates of smoking. Methods: The age- and gender-stratified smoking prevalence in the United States from 2000 to 2040 were obtained from the U.S. Census Bureau and the U.S. Surgeon General's Smoking Report. PD prevalence was estimated based on population aging with and without an account of the impact of declining smoking rates. Relative risks of 0.56 and 0.78 were applied for current and former smokers, respectively. Results: Accounting for aging alone, ∼700,000 PD cases are predicted by 2040. After accounting for the declining smoking prevalence, ∼770,000 cases, an increase of ∼10% over the estimate without smoking, is predicted. Conclusions: If the epidemiological association of smoking and PD is causal, projecting future cases without considering smoking may underestimate disease burden, underscoring the urgency of adequate resource allocation. © 2017 International Parkinson and Movement Disorder Society.
... The economic cost of PD in the US has been estimated of $23 billion per year (in 2002 dollars). Other estimations indicate a total cost of $10.78 billion per year or $21,626 per patient per year (in 2007 dollars) (O'Brien et al., 2009). In Europe, the 2010 estimated cost of PD was €13.9 billion (Gustavsson et al., 2011). ...
Article
Particulate Matter (PM) pollution still represents a great concern for its adverse effects on human health. Among the emerging risks, the neuro-toxicity of PM-associated metals has been evidenced by the scientific literature. Since PM inhalation plays an important role with respect to its toxicity, there is a recognized need for improving the studies with respect to its deposition sites. This work is focused on the assessment of PM10-associated metals in the urban environment of Turin (NW Italy), one of the most polluted European areas. Data of PM10-associated metals mass size distribution, percentage repartition associated to the respiratory appa-ratus, relative concentration peaks, together with preferential deposition sites and the daily inhaled dose have been calculated. The analyzed metals were: As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Sn, V and Zn. The data are limited, considering a precautionary approach, to the winter season, when the intensity and number of sources is greater and only in the case of stable good weather conditions, when the atmospheric removal pro-cesses have a more limited impact on the aerosol dynamics. The results show that the element concentrations in Torino atmospheric PM are similar to those of other considered European towns. The measures evidence a preferential association of each metal with different areas of the respiratory apparatus Furthermore, ordering the analyzed metals with respect to the daily inhaled dose, from higher to lower, we have: Fe, Zn, Sn, Cd, Mn, Cu, Pb, Ni, Cr, Mo, V, As and Co. Even if the risk doesn’t seem to be significant up to now (apart from Cr), the evolving knowledge on the effects of chronic sub-threshold exposure might give a different evidence in the future. PM10 size repartition measurement, together with the analysis of PM10-associated compounds, could well intermittently complement the routine air quality measures with the purpose of increasing the present body of knowledge with respect to PM neurotoxicity, allowing to improve both the existing risk assessment procedures and the public health management.
... Second, studies usually report indirect costs in an inconsistent and often incomplete way. Whereas most include productivity loss due to early retirement and sick leave, very few [10] refer to mortality costs due to premature death. Only one study included presenteeism (productivity reduction while working) as part of indirect costs.[57] ...
Article
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Parkinson's disease (PD) is a progressive, neurodegenerative disorder whose symptoms and manifestations greatly deteriorate the health, functional status and quality of life of patients, has severe consequences on their families and caregivers and supposes a challenge for the healthcare system and society. The aim of this paper is to comprehensively and descriptively review studies on the economic impact of the disease and interventions, analyzing major contributing factors to direct and indirect costs in PD. Cost-of-illness studies have shown that costs of PD are high, mainly due to drug, hospitalization and productivity loss, and tend to increase as the disease progresses. Studies on PD treatment have suggested that therapies for advanced PD (levodopa/carbidopa intestinal gel and apomorphine) and surgical procedures are cost-effective and cost saving, despite their high expenditures; however, further research such as on the economic impact of non-motor manifestations or on the cost-effectiveness of non-medical interventions is still needed.
... Over the next 15 years, this number will almost double to 9 million patients worldwide (Dorsey et al., 2007). Already today, the costs to public health are enormous-estimated at $10.8 billion annually in the USA alone (O'Brien et al., 2009). There are no cures or disease-modifying therapies for Parkinson's disease, and this may be due in part to our inability to monitor biological markers of early disease. ...
Article
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There are no cures for neurodegenerative diseases and this is partially due to the difficulty of monitoring pathogenic molecules in patients during life. The Parkinson's disease gene α-synuclein (SNCA) is selectively expressed in blood cells and neurons. Here we show that SNCA transcripts in circulating blood cells are paradoxically reduced in early stage, untreated and dopamine transporter neuroimaging-supported Parkinson's disease in three independent regional, national, and international populations representing 500 cases and 363 controls and on three analogue and digital platforms with P < 0.0001 in meta-analysis. Individuals with SNCA transcripts in the lowest quartile of counts had an odds ratio for Parkinson's disease of 2.45 compared to individuals in the highest quartile. Disease-relevant transcript isoforms were low even near disease onset. Importantly, low SNCA transcript abundance predicted cognitive decline in patients with Parkinson's disease during up to 5 years of longitudinal follow-up. This study reveals a consistent association of reduced SNCA transcripts in accessible peripheral blood and early-stage Parkinson's disease in 863 participants and suggests a clinical role as potential predictor of cognitive decline. Moreover, the three independent biobank cohorts provide a generally useful platform for rapidly validating any biological marker of this common disease. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
... Current socio-economic burden per PD patient per year is estimated to be US$ 24,000. 6 Further, the increase in cost was found to be six times higher for patients in the late stages of PD compared to early stages. 7,8,9 Epidemiological studies have found that Parkinsonism is prevalent to a varying degree in all countries that have been studied to date. ...
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The prevalence of Parkinson's disease (PD), the second most common neurodegenerative disorder, is increasing day by day and poses a great threat to the elderly population. Its main neuropathological feature is the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc). However, the pathogenesis of PD is not understood fully. Clinical, experimental, microanatomic, and biochemi-cal evidence suggest PD involves multifactorial oxidative neurodegeneration. The SNpc is uniquely vulnerable to oxidative damage, having a high content of oxidiz-able dopamine, neuromelanin, polyunsaturated fatty acids, and iron, and relatively low antioxidant complement with high metabolic rate. The aim of this review is to bring out the incidence of PD in India compared to that of Europe. Since ancient times plants have been valued for their medicinal properties, and many cultures still rely on plants as their major source of medicine. In this review we discuss the role of Indian medicinal plants in countering free-radical damage and also give you a glimpse about the clinical and pathological features of PD, available treatments, their drawbacks, and future challenges to overcome PD.
... us annual direct costs were estimated at $6.2 billion, with a total expenditure estimate of $11 billion when indirect costs are included. 11 Although these costs are approximately half of the estimated total costs reported by others, this study demonstrates that costs increase significantly when pD patients are transferred to institutional care. ...
Article
Maintenance of symptom control in Parkinson's disease (PD) requires continuous titration of medication and addition of multiple therapies over the course of the disease. Adherence to medication is vital to symptom control and key to maximizing the efficacy of existing therapies. However, adherence is compromised by a variety of factors, including motor symptoms, complex dosing regimens, multiple medications, and lack of patient/physician awareness of the impact and prevalence of suboptimal adherence. This retrospective, longitudinal cohort study assessed the prevalence of suboptimal adherence [measured as the medication possession ratio (MPR)] to PD medications, and its impact on the worsening of PD symptoms (measured as increase in monotherapy dose, augmentation of therapy, PD-related emergency department visit, or hospitalization), in a Medicare Health Maintenance Organization population in the United States. Irrespective of the MPR threshold chosen, a high percentage of patients were categorized as suboptimally adherent to their PD medications, and patients with suboptimal adherence to their PD medications had higher risks of worsening of PD symptoms, compared with those who were adherent. Increased awareness of both the magnitude and impact of suboptimal adherence to PD medications, coupled with dosage simplification and a unified effort by healthcare professionals and patients, may improve adherence to PD medications and ultimately improve symptom control.
Article
To examine 1) the effect of prior antiparkinson drug (APD) nonadherence on subsequent APD regimen modifications; and 2) the influence of modifications on healthcare utilization and costs by patients with Parkinson's disease (PD). This retrospective cohort study included 7052 PD patients with ≥2 APD prescriptions who initiated a modification of APD regimens in 2007. Modification was assessed as changing from one APD to another and/or adding a new APD to an existing regimen. Nonadherence was measured using Medication Possession Ratio <0.8. Discrete-time survival analyses were used to estimate the effect of prior nonadherent behavior on initiating APD modifications. Generalized linear models were used to estimate the effect of initiating medication modifications on subsequent 3-month medical use and costs. Initiation of APD modifications in any given month was higher among patients who were nonadherent to APDs in the preceding month (adjusted hazard ratio [HR] = 1.23), compared to their adherent counterparts. Modifications significantly predicted higher risk of all-cause and PD-related hospitalizations (adjusted relative risk [RR] = 1.22 and 1.83, respectively), home health agency utilization (RR = 1.18 and 1.52), and use of physician services (RR = 1.14 and 1.41), as well as higher total all-cause healthcare expenditures (mean = $1064) in any given 3-month interval. Prior nonadherence to APDs might influence initiation of APD modification. APD modifications were associated with increased health care utilization and expenditures, with the caveats that indications of modifications and disease severity may still play roles. Prescribers should consider patients' medication adherence when changing APD regimens to lower the costs of medical services. Copyright © 2014 Elsevier Ltd. All rights reserved.
Article
This study examined the treatment patterns, direct healthcare costs and predictors of treatment costs associated with levodopa-induced dyskinesia (LID) in Parkinson's disease (PD). This retrospective cohort study followed PD patients for 1-year pre- and post-onset of LID, using a large US health insurance claims database from January 1, 2004 to December 31, 2008. Patients with LID were matched to patients without LID based on propensity scores to control for potential selection bias. Descriptive statistics and bootstrap techniques were employed to assess patient demographic and clinical characteristics and costs incurred. Factors influencing treatment costs were analyzed using a generalized linear model with log-link function and gamma distribution. Costs were adjusted to 2009 prices. After patients developed LID, their total treatment costs were increased from $18,645 during the 12 months preceding LID onset to $26,439 for the 12-month period subsequent to LID onset (incremental costs of $7795: P<0.001). PD-related costs increased from $3917 to $8110 (incremental costs of $4194: p<0.001) LID events, medical resource utilization, higher levodopa dosage, and use of alternative PD medications were associated with increases in total treatment costs. Few changes in medication treatment patterns were noted following the initial LID, with only slight increases in levodopa dosage and few additions of alternative agents. In the United States, PD patients with LID impose a significant economic burden when compared to patients without LID. Currently available, treatment strategies for dyskinesia should be used more frequently in PD management, and new treatment strategies should be considered as they may lower healthcare costs.
Article
No recent analysis details Parkinson's Disease (PD) costs or survival for Medicare beneficiaries. This study assesses excess direct costs and survival in Medicare beneficiaries with early and advanced PD. Patients with ≥ 2 PD diagnoses (ICD-9-CM: 332.0), ≥ age 65, continuously enrolled in Parts A&B during one-year baseline and study periods were selected from the Medicare 5% sample (N = 3.2 million, 1999-2008). Newly diagnosed patients were defined as having no baseline claims for movement disorder, dementia, Alzheimer's, bipolar disorder, psychosis, falls or related injuries, ambulatory assistance device (walker or wheelchair), or skilled nursing facility. Controls without PD were demographically matched 1:1. Costs to Medicare were compared via Wilcoxon rank-sum tests and inverse probability weighted multivariate regression. Survival was assessed via Cox proportional hazards analysis. Costs in the year post-diagnosis were higher for newly diagnosed patients (N = 9,201, $7423) than controls ($5024), resulting in excess PD-associated costs of $2399 (p < 0.001). Cumulative excess costs were $28,422 from the year prior to index quarter to five years following (p < 0.01). PD patients receiving their first claim for an ambulatory assistance device (N = 11,294) had excess cumulative costs of $50,923 (p < 0.001) over the same period; those receiving their first claim for a skilled nursing facility (N = 10,152) had excess costs of $102,750 (p < 0.001). Hazard rates of mortality were higher among newly diagnosed PD (1.43, p < 0.001), ambulatory assistance device (2.37, p < 0.001) and skilled nursing facility (3.34, p < 0.001) cohorts than in corresponding non-PD groups. Medicare beneficiaries with PD have substantially and progressively higher costs and mortality compared with controls.
Article
Full-text available
The prevalence of Parkinson’s disease (PD), the second most common neurodegenerative disorder, is increasing day by day and poses a great threat to the elderly population. Its main neuropathological feature is the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc). However, the pathogenesis of PD is not understood fully. Clinical, experimental, microanatomic, and biochemical evidence suggest PD involves multifactorial oxidative neurodegeneration. The SNpc is uniquely vulnerable to oxidative damage, having a high content of oxidizable dopamine, neuromelanin, polyunsaturated fatty acids, and iron, and relatively low antioxidant complement with high metabolic rate. The aim of this review is to bring out the incidence of PD in India compared to that of Europe. Since ancient times plants have been valued for their medicinal properties, and many cultures still rely on plants as their major source of medicine. In this review we discuss the role of Indian medicinal plants in countering free-radical damage and also give you a glimpse about the clinical and pathological features of PD, available treatments, their drawbacks, and future challenges to overcome PD.
Article
There is an ongoing debate about generic drug use for a multitude of conditions including epilepsy, psychosis, hypertension, post-organ transplantation, and several infectious diseases. Most of the concerns involve drugs with narrow therapeutic indices. There is a heightened attention to health care costs and macroeconomic policy as well as microeconomic business decisions that may impact the use of generic drugs. The issues surrounding generic substitution for chronic degenerative conditions such as in Parkinson's disease (PD) continue to be controversial subjects for physicians, pharmacists, patients, Medicare/governmental insurance programs, and for private insurance companies. The United States Food and Drug Administration (FDA) requires that generic drugs meet a standard for bioequivalence prior to market approval, but this may not translate to therapeutic efficacy or to overall patient tolerance. In this review we will address issues related to the use of generics versus branded drugs in PD, and the potential impact substitution of generics may have on patients and on clinicians. Having proper documentation may help in deciding the appropriate usage of these drugs in PD. Medicare, governmental run health care systems, and third party insurance companies should in a complex disease such as PD, allow physicians and patients the chance to properly document the superiority of brand versus generic approaches. Currently, in the U.S, and in many countries around the world, there is no obligation for payers to respect these types of patient specific bedside trials, and there has been no standardization of the process.
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The results of uncontrolled, open-label clinical trials indicate that reconstructive cellular therapies have the capacity to produce meaningful functional improvements in patients with brain disorders. However, the transplantation of fetal cells has not progressed to viable best practice treatment for any brain disorder. A conceptual approach, referred to as the Repair Model, has served as a useful heuristic for initiating research in the field and guiding the development of new practices. Analysis of evidence for the treatment of Parkinson's disease indicates that recovery following neural grafting is a complex process influenced by factors beyond the replacement of neurons. An alternative approach, the Composite Brain Model, is outlined to address limitations of the Repair Model. A hierarchical, open-system model is proposed, which aims to track the interactions between the grafted cells, the host brain, and the environment. The Composite Brain Model emphasizes the importance of the interactions between the patient, their physical and social environment, and the provision of rehabilitation during recovery. It is proposed that the Composite Brain Model is useful in providing an alternative perspective for research, theory building, and practice.
Article
Full-text available
Parkinson's disease (PD) is a complex, progressive and disabling neurodegenerative disorder marked by progressive loss of nigrostriatal dopaminergic neurons which is related to a continuous impairment of motor functions. As pharmacological treatments (L-Dopa, Dopamin Agonists) are lowly effective with respect to postural disturbance, and furthermore they lose effectiveness with disease progression potent nonpharmacologic therapies, are of crucial importance for the management of impairments. Besides traditional types of exercise, like strength or endurance training, whole body vibration was found having positive influence on PD motor symptoms. The aim of this work is to present a suitable review about the published papers found in the PubMed in which there are information about the use of the whole body vibration in patients with PD. Using the keywords "Parkinson's disease" or "Parkinson's disease" associated with "whole body vibration" six publications were found. One publication among the six, it was about vibration delivered in the entire body produced by a physioacoustic chair and it was also not analyzed in this work. Five papers among six were selected after a search in the PubMed using the keywords "Parkinson´s disease" and "whole body vibration". The frequency used in four of these five papers is the same (6Hz). Only a paper presents a frequency of 25Hz. The positive findings indicated in the papers seem in depend on the frequency and they were found with 6 or 25 Hz. Only in a publication has not presented difference between the clinical conditions in the experimental (whole body vibration) and control (placebo). All the other authors have noticed positive clinical findings using the oscillating platform. It is highly relevant in the development of clinical procedures to the management of patients with PD. As the use of the oscillating platforms is very inexpensive and positive clinical findings have been noticed with the use of whole body vibration in patients with PD, it is suggested to implement the studies involving the application of the exercises with whole body vibration in oscillating platforms to manage the patients with PD.
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