title: Treatment benefit and daily drug costs associated with treating Parkinson's disease in a Parkinson's disease clinic.
abstract: OBJECTIVE
  In some countries, such as Germany, there has been a move towards the treatment of patients with Parkinson's disease in specialised inpatient units. However, data on patient outcome and the daily costs of antiparkinsonian drugs in these settings are rare. This study was conducted to determine the effect of an inpatient setting (a specialised Parkinson's disease clinic) on drug therapy costs and patient symptoms.
  
  
  METHODS
  This study involved 63 consecutively referred inpatients of a Parkinson's disease clinic. On entry to the clinic, the patients' antiparkinsonian drug regimen was titrated in order to improve their motor function. The daily costs of drug therapy per patient (in 2002 values) were calculated, and the severity of Parkinson's disease symptoms scored via scores on the Unified Parkinson's Disease Rating Scale (UPDRS) and standardised instrumental procedures (peg insertion and tapping), both initially and at the end of the patients' stay in the clinic. The variables between the two evaluation timepoints were compared.
  
  
  RESULTS
  The titration of antiparkinsonian drugs was associated with a significant decrease in the symptoms of Parkinson's disease at discharge from the clinic compared with admission (as measured by UPDRS total and subscale scores [all p < 0.001], and, to a lesser extent, by peg insertion and tapping [both p < 0.05]). A significant increase in daily drug costs (an increase of euro14.11 per patient for all drugs and euro12.36 per patient for antiparkinsonian drugs [both p <0.001]) was also observed.
  
  
  CONCLUSIONS
  The results demonstrate that the symptoms experienced by patients with Parkinson's disease improve after performance of antiparkinsonian drug titration within the setting of a specialised Parkinson's disease clinic. The effect on symptoms was seen most clearly with the UPDRS, although both peg insertion and tapping reflected this improvement to a certain extent. Drug titration resulted in, on average, a doubling of daily drug costs. Future trials are needed to investigate the long-term effects of such a hospital stay on indirect costs associated with treating Parkinson's disease, and on caregiver burden, and also to compare the efficacy of a Parkinson's disease clinic with an outpatient setting.
authors.affiliation: Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany. thomas.mueller@ruhr-uni-bochum.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Birgit
authors.initials: B
authors.lastname: Voss
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hellwig
authors.forename: Franz
authors.initials: F
authors.lastname: Josef Stein
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schulte
authors.forename: Horst
authors.initials: H
authors.lastname: Przuntek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006782:Hospitals, Special; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects; D010300:Parkinson Disease / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects; D012720:Severity of Illness Index
chemical_list: D000978:Antiparkinson Agents