title: [Apomorphine therapy versus deep rain stimulation. Clinical and economic aspects in patients with advanced Parkinson disease].
abstract: Long-term dopaminergic treatment of Parkinson's disease is complicated by the occurrence of dyskinesia and motor fluctuations and is responsible for increasing the costs of treatment. In these patients, continuous subcutaneous therapy with the dopamine agonist apomorphine or deep-brain stimulation represents a promising strategy. While the costs for the treatment with apomorphine are covered by health insurance, separate reimbursement for deep-brain stimulation does not exist in Germany. The case reports (n = 3) presented here emphasize that deep-brain stimulation is less cost-intensive than subcutaneous treatment with apomorphine in selected patients. Even in the first postoperative year costs for medication and hospital stays were reduced by approximately 60%. Moreover, in all three patients, motor complications improved after deep-brain stimulation in comparison to previous subcutaneous application of apomorphine. Thus, to further ensure deep-brain stimulation in parkinsonian patients it is mandatory to find a mode of reimbursement for the institutions concerned.
authors.affiliation: Neurologische Klinik und Poliklinik, Humboldt-Universität, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin.
authors.forename: W
authors.initials: W
authors.lastname: Meissner
authors.forename: T
authors.initials: T
authors.lastname: Trottenberg
authors.forename: S
authors.initials: S
authors.lastname: Klaffke
authors.forename: G
authors.initials: G
authors.lastname: Paul
authors.forename: A A
authors.initials: AA
authors.lastname: Kühn
authors.forename: G
authors.initials: G
authors.lastname: Arnold
authors.forename: K M
authors.initials: KM
authors.lastname: Einhäupl
authors.forename: A
authors.initials: A
authors.lastname: Kupsch
mesh_terms: D000368:Aged; D001058:Apomorphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D004599:Electric Stimulation Therapy / Q000191:economics / Q000295:instrumentation; D005917:Globus Pallidus / Q000503:physiopathology; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000191:economics; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010300:Parkinson Disease / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D019736:Prostheses and Implants / Q000191:economics; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000503:physiopathology
chemical_list: D001058:Apomorphine