title: Cost analysis of the treatments for patients with advanced Parkinson's disease: SCOPE study.
abstract: OBJECTIVE
  To perform a comparative long-term analysis of the associated healthcare costs for the therapeutic options in advanced Parkinson's Disease (PD): deep brain stimulation (DBS), continuous duodenal levodopa-carbidopa infusion (CDLCI), and continuous subcutaneous apomorphine infusion (CSAI).
  
  
  METHODS
  Resource use associated with the pre-treatment period, procedure, and follow-up was assessed for the three therapies from the perspective of the Spanish national healthcare system. Resources consumption was measured with a Healthcare Resources Questionnaire (at nine advanced PD centres). Unit costs (Euro-Spain 2010) were applied to measure resource use to obtain the average total cost for each therapy over 5 years.
  
  
  RESULTS
  Mean cumulative 5-year cost per patient was significantly lower with DBS (€88,014) vs CSAI (€141,393) and CDLCI (€233,986) (p < 0.0001). DBS was associated with the lowest cumulative costs from year 2, with a yearly average cost of €17,603 vs €46,797 for CDLCI (p = 0.001) and €28,279 for CSAI (p = 0.008). For every patient treated annually with CDLCI, two could be treated with DBS (or €29,194 could be saved) and for every patient treated with CSAI, €10,676 could be saved with DBS. The initial DBS investment (32.2% of the total 5-year costs) was offset by decreases in anti-Parkinsonian drugs and follow-up costs. CDLCI and CSAI required constant drug use (i.e., levodopa and carbidopa for CDLCI, apomorphine for CSAI), representing ∼95% of their total 5-year cost.
  
  
  CONCLUSIONS
  All costs were based on a questionnaire, not on actual clinical data. The study is not a cost-effectiveness analysis as there is a lack of comparable outcomes data. An expert panel was used due to the complexity and variability in the treatment of advanced PD. The sample size was relatively small.
  
  
  CONCLUSIONS
  Overall, DBS requires less use of health resources than CDLCI or CSAI in advanced PD patients, mostly pharmacological. The initial DBS investment was offset at year 2 by reductions in the ongoing consumption of anti-Parkinsonian medication. For every patient treated annually with CDLCI or CSAI, substantial cost savings could be made with DBS.
authors.affiliation: Neurology Services, Movement Disorders Unit, Hospital Clinic i Provincial, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Valldeoriola
authors.forename: Jaume
authors.initials: J
authors.lastname: Puig-Junoy
authors.forename: Ruth
authors.initials: R
authors.lastname: Puig-Peiró
mesh_terms: D000978:Antiparkinson Agents / Q000191:economics*; D002230:Carbidopa / Q000191:economics; D003365:Costs and Cost Analysis / Q000379:methods; D046690:Deep Brain Stimulation / Q000191:economics*; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007980:Levodopa / Q000191:economics; D010300:Parkinson Disease / Q000191:economics / Q000628:therapy*; D012720:Severity of Illness Index; D013030:Spain; D011795:Surveys and Questionnaires
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa; D002230:Carbidopa