title: Pharmacoeconomic considerations of treating patients with advanced Parkinson's disease.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Philipps-University Marburg, Department of Neurology, Baldingerstrasse, 35043 Marburg, Germany.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Reese
authors.forename: Judith
authors.initials: J
authors.lastname: Dams
authors.forename: Yaroslav
authors.initials: Y
authors.lastname: Winter
authors.forename: Monika
authors.initials: M
authors.lastname: Balzer-Geldsetzer
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
mesh_terms: D000978:Antiparkinson Agents / Q000191:economics / Q000627:therapeutic use*; D017850:Economics, Pharmaceutical; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy*; D012720:Severity of Illness Index
chemical_list: D000978:Antiparkinson Agents