title: Higher levels of apomorphine and rotigotine prescribing reduce overall secondary healthcare costs in Parkinson's disease.
abstract: BACKGROUND
  Parkinson's disease (PD) affects around 100,000 people in England. A number of non-oral therapies can improve both the quality of life and reduce patient needs for health and social care. However, these can be relatively expensive at £2000-£10,000 per year per patient. Our aim was to examine how prescribing of these agents relates to secondary care costs.
  
  
  METHODS
  Using practice level primary care prescribing data and hospital episode statistical data in England, we investigated the relation between general practitioner prescriptions of apomorphine injections/rotigotine patches and the secondary care costs accrued for their diagnosed PD patients for 2011-2014. The median age of the PD patients was 78 years.
  
  
  RESULTS
  In the period 2011-2014, 58% of the average annual £437 million secondary care costs for PD patients came from non-elective admissions. 80% of this came from seven Healthcare Resource Group Chapters linked to PD comorbidities. Compared with practices not using non-oral therapies, practices prescribing Apomorphine saved £897 per year per patient of secondary care costs to offset the average additional prescribing cost of £475 per overall patient per year. For Rotigotine, saving was £718 per year per patient of secondary care costs offsetting £137 prescribing cost. Practices in the highest quartile of non-oral prescribing were using non-oral agents in up to 28% of their PD patients.
  
  
  CONCLUSIONS
  Those practices which used more non-oral therapies appear to incur less secondary care costs. A total of 70% of the advanced PD patients are not being given access to non-oral treatment. This is a challenge for all physicians looking after the older patient.
authors.affiliation: The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Heald
authors.affiliation: Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK.
authors.forename: M
authors.initials: M
authors.lastname: Livingston
authors.affiliation: RES Consortium, Andover, UK.
authors.forename: M
authors.initials: M
authors.lastname: Stedman
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Wyrko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001058:Apomorphine / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000191:economics; D004739:England; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013764:Tetrahydronaphthalenes / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*
chemical_list: D013764:Tetrahydronaphthalenes; D013876:Thiophenes; C047508:rotigotine; D001058:Apomorphine