title: Prospective study on cost-effectiveness of home-based motor assessment in Parkinson's disease.
abstract: Introduction Treatment adjustments in Parkinson's disease (PD) are in part dependent on motor assessments. The aim of this study was to evaluate the cost-effectiveness of home-based motor monitoring plus standard in-office visits versus in-office visits alone in patients with advanced PD. Methods The procedures consisted of a prospective, one-year follow-up, randomized, case-control study. A total of 40 patients with advanced PD were randomized into two groups: 20 patients underwent home-based motor monitoring by using wireless motion sensor technology, while the other 20 patients had in-office visits. Motor and non-motor symptom severities, quality of life, neuropsychiatric symptoms, and comorbidities were assessed every four months. Direct costs were assessed using a standardized questionnaire. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). Results Both groups of PD patients were largely comparable in their clinical and demographic variables at baseline; however, there were more participants using levodopa-carbidopa intestinal gel in the home-based motor monitoring group. There was a trend for lower Unified Parkinson's Disease Rating Scale functional status (UPDRS II) scores in the patients monitored at home compared to the standard clinical follow-up ( p = 0.06). However, UPDRS parts I, III, IV and quality-adjusted life-years scores were similar between both groups. Home-based motor monitoring was cost-effective in terms of improvement of functional status, motor severity, and motor complications (UPDRS II, III; IV subscales), with an ICER/UPDRS ranging from €126.72 to €701.31, respectively. Discussion Home-based motor monitoring is a tool which collects cost-effective clinical information and helps augment health care for patients with advanced PD.
authors.affiliation: 1 Neurology Department, Hospital Universitario of Burgos, Burgos, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Cubo
authors.affiliation: 1 Neurology Department, Hospital Universitario of Burgos, Burgos, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Mariscal
authors.affiliation: 1 Neurology Department, Hospital Universitario of Burgos, Burgos, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Solano
authors.affiliation: 2 Health Econometric Consultant, Hospital Universitario, Burgos, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Becerra
authors.affiliation: 3 Statistical Consultant, Neurology Department, Hospital Universitario Burgos, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Armesto
authors.affiliation: 4 Research Unit, Hospital Universitario of Burgos, Burgos, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Calvo
authors.affiliation: 4 Research Unit, Hospital Universitario of Burgos, Burgos, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Arribas
authors.affiliation: 5 Centro Servicios Avanzados, Burgos, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Seco
authors.affiliation: 5 Centro Servicios Avanzados, Burgos, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Martinez
authors.affiliation: 5 Centro Servicios Avanzados, Burgos, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Zorrilla
authors.affiliation: 6 Great Lakes NeuroTechnologies, Cleveland, USA.
authors.forename: D
authors.initials: D
authors.lastname: Heldman
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000191:economics / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods*; D010300:Parkinson Disease / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology; D011446:Prospective Studies; D017216:Telemedicine / Q000379:methods
keywords: Parkinson’s disease; cost-effectiveness; expenses; telemedicine