[Cost analysis in Italy of various strategies for the treatment of Parkinson disease in the advanced phase].
OBJECTIVE
To perform a comparative economic evaluation of therapies--L-dopa drugs, subcutaneous infusion of apomorphine and surgical intervention of Deep Brain Stimulation (DBS)--for the treatment of advanced Parkinson's disease (APD) and to verify the level of assistance guaranteed in Italy to patients affected by APD.


METHODS
Literature review and Delphi Panel to collect data about the efficacy of the therapies for the treatment of APD and the use of healthcare resources for such therapies. Field survey to investigate financing mechanisms of the therapeutical alternatives in the Italian regions; cost-analysis over five years (NHS perspective); cost-analysis (hospital perspective) for the initial administration of therapeutic alternatives.


RESULTS
Literature review shows that the reduction of the "off-periods" is 62% for Apomorphine and 80-90% for DBS compared to traditional therapy. The 5-years economic analysis from the NHS perspective shows that the cost of a patients with APD is [symbol: see text] 58.065 if treated with traditional therapy, [symbol: see text] 36.423 (including infusional pump and the drug) with subcutaneous apomorphine and respectively [symbol: see text] 56.489 and [symbol: see text] 41.379 (depending on reimbursement of electrodes and neurostimulator on top of the DRG tariff) with DBS. The field survey, highlighted that Regions which currently reimburse the infusion pump for apomorphine and the electrodes and neurostimulator for DBS--on top of the DRG tariff--are a very limited number.


CONCLUSIONS
Apomorphine and DBS in the treatment of APD show higher efficacy and lower costs compared to traditional therapy.
D'Ausilio
Anna
A
Chiesi Farmaceutici, Parma. anna.dausilio@pbe.it
Marconi
Stefano
S
Antonini
Angelo
A
Tamma
Filippo
F
Valzania
Franco
F
Berto
Patrizia
P
D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use; D001058:Apomorphine / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D018491:Dopamine Agonists / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D004599:Electric Stimulation Therapy / Q000191:economics; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006306:Health Surveys; D017721:Hospital Costs; D006801:Humans; D007260:Infusion Pumps / Q000191:economics; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007558:Italy; D007980:Levodopa / Q000191:economics / Q000627:therapeutic use; D009313:National Health Programs / Q000191:economics; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data; D010300:Parkinson Disease / Q000188:drug therapy / Q000191:economics* / Q000628:therapy
D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D007980:Levodopa; D001058:Apomorphine