Advertisement

Journal of Neurology

, Volume 258, Issue 8, pp 1497–1506 | Cite as

The health-related, social, and economic consequences of parkinsonism: a controlled national study

  • Poul JennumEmail author
  • Marielle Zoetmulder
  • Lise Korbo
  • Jakob Kjellberg
Original Communication

Abstract

Parkinson’s disease (PD) and atypical parkinsonism (AP) cause a significant socioeconomic burden, but there is insufficient information about the total disease burden at a national level. Thus, the goal of this study was to estimate the excess direct and indirect costs of PD and AP in a national sample. Using records from the Danish National Patient Registry (1997–2007), 13,400 PD and 647 AP patients were identified and compared with, respectively, 53,600 and 2,588 control cases randomly selected with respect to age, gender, civil status, and geographic location. Direct costs including frequencies of primary and sector contacts and procedures, and medication from primary and secondary sectors were obtained from the Danish Ministry of Health, the Danish Medicines Agency, and the National Health Security. Indirect costs, which included labor supply and social transfer payments, were based on income data derived from the Coherent Social Statistics. Patients with PD and AP had significantly higher rates of health-related contact and medication use and a higher socioeconomic cost. Furthermore, they had very low employment rates, and those in employment had a lower income level than employed control subjects. The annual mean excess health-related cost was €6,500 ($8,975/£5,543) and €9,771 ($13,491/£8,332) for each patient with PD and AP, respectively. In addition, the patients with PD and AP received an annual mean excess social transfer income of €324 (£276/$447) and €844 (£719/$1,165), respectively. The employment- and health-related consequences could be identified up to 8 years before the first diagnosis and increased with disease advancement. PD and AP have major socioeconomic consequences for patients and society. The health effects are present for up to more than 8 years before a diagnosis of PD/AP.

Keywords

Parkinson’s disease Illness costs Health costs Economic burden Employment 

Notes

Acknowledgments

The study was supported by a grant from the National Health Board.

Conflict of interests

There are no conflicts of interests among the authors.

References

  1. 1.
    de Rijk MC, Tzourio C, Breteler MM et al (1997) Prevalence of parkinsonism and Parkinson’s disease in Europe: the EUROPARKINSON Collaborative Study European Community Concerted Action on the Epidemiology of Parkinson’s disease. J Neurol Neurosurg Psychiatry 62:10–15PubMedCrossRefGoogle Scholar
  2. 2.
    Wickremaratchi MM, Perera D, O’Loghlen C et al (2009) Prevalence and age of onset of Parkinson’s disease in Cardiff: a community based cross sectional study and meta-analysis. J Neurol Neurosurg Psychiatry 80:805–807PubMedCrossRefGoogle Scholar
  3. 3.
    Yamawaki M, Kusumi M, Kowa H, Nakashima K (2009) Changes in prevalence and incidence of Parkinson’s disease in Japan during a quarter of a century. Neuroepidemiology 32:263–269PubMedCrossRefGoogle Scholar
  4. 4.
    Newman EJ, Grosset KA, Grosset DG (2009) Geographical difference in Parkinson’s disease prevalence within West Scotland. Mov Disord 24:401–406PubMedCrossRefGoogle Scholar
  5. 5.
    Pedersen KF, Larsen JP, Alves G, Aarsland D (2009) Prevalence and clinical correlates of apathy in Parkinson’s disease: a community-based study. Parkinsonism Relat Disord 15:295–299PubMedCrossRefGoogle Scholar
  6. 6.
    Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R (2007) How common are the “common” neurologic disorders? Neurology 68:326–337PubMedCrossRefGoogle Scholar
  7. 7.
    Guttman M, Slaughter PM, Theriault ME, DeBoer DP, Naylor CD (2001) Parkinsonism in Ontario: increased mortality compared with controls in a large cohort study. Neurology 57:2278–2282PubMedGoogle Scholar
  8. 8.
    Singer E (1973) Social costs of Parkinson’s disease. J Chronic Dis 26:243–254PubMedCrossRefGoogle Scholar
  9. 9.
    McRae C, Sherry P, Roper K (1999) Stress and family functioning among caregivers of persons with Parkinson’s disease. Parkinsonism Relat Disord 5:69–75PubMedCrossRefGoogle Scholar
  10. 10.
    Caap-Ahlgren M, Dehlin O (2002) Factors of importance to the caregiver burden experienced by family caregivers of Parkinson’s disease patients. Aging Clin Exp Res 14:371–377PubMedGoogle Scholar
  11. 11.
    Dowding CH, Shenton CL, Salek SS (2006) A review of the health-related quality of life and economic impact of Parkinson’s disease. Drugs Aging 23:693–721PubMedCrossRefGoogle Scholar
  12. 12.
    Karlsen KH, Tandberg E, Arsland D, Larsen JP (2000) Health related quality of life in Parkinson’s disease: a prospective longitudinal study. J Neurol Neurosurg Psychiatry 69:584–589PubMedCrossRefGoogle Scholar
  13. 13.
    Korchounov A, Bogomazov G (2006) Employment, medical absenteeism, and disability perception in Parkinson’s disease: a pilot double-blind, randomized, placebo-controlled study of entacapone adjunctive therapy. Mov Disord 21:2220–2224PubMedCrossRefGoogle Scholar
  14. 14.
    Schrag A, Banks P (2006) Time of loss of employment in Parkinson’s disease. Mov Disord 21:1839–1843PubMedCrossRefGoogle Scholar
  15. 15.
    Diem-Zangerl A, Seppi K, Wenning GK, Trinka E, Ransmayr G, Oberaigner W, Poewe W (2009) Mortality in Parkinson’s disease: a 20 year follow-up study. Mov Disord 24:819–825PubMedCrossRefGoogle Scholar
  16. 16.
    Forsaa EB, Larsen JP, Wentzel-Larsen T, Alves G (2010) What predicts mortality in Parkinson disease? A prospective population-based long-term study. Neurology 75(14):1270–1276PubMedCrossRefGoogle Scholar
  17. 17.
    Montgomery EB Jr (2009) Basal ganglia pathophysiology in Parkinson’s disease. Ann Neurol 65:618 author reply 618–619PubMedCrossRefGoogle Scholar
  18. 18.
    Bartels AL, Leenders KL (2009) Parkinson’s disease: the syndrome, the pathogenesis and pathophysiology. Cortex 45:915–921PubMedCrossRefGoogle Scholar
  19. 19.
    Weintraub D, Comella CL, Horn S (2008) Parkinson’s disease–part 1: pathophysiology, symptoms, burden, diagnosis, and assessment. Am J Manag Care 14:S40–S48PubMedGoogle Scholar
  20. 20.
    Montgomery EB Jr (2006) Practice parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 67:2266 author reply 2266PubMedCrossRefGoogle Scholar
  21. 21.
    Olanow CW, Stern MB, Sethi K (2009) The scientific and clinical basis for the treatment of Parkinson disease (2009). Neurology 72:S1–S136PubMedCrossRefGoogle Scholar
  22. 22.
    Lang AE (2009) When and how should treatment be started in Parkinson disease? Neurology 72:S39–S43PubMedCrossRefGoogle Scholar
  23. 23.
    Stacy M, Galbreath A (2008) Optimizing long-term therapy for Parkinson disease: levodopa, dopamine agonists, and treatment-associated dyskinesia. Clin Neuropharmacol 31:51–56PubMedCrossRefGoogle Scholar
  24. 24.
    Stacy M, Galbreath A (2008) Optimizing long-term therapy for Parkinson disease: options for treatment-associated dyskinesia. Clin Neuropharmacol 31:120–125PubMedCrossRefGoogle Scholar
  25. 25.
    Braak H, Rub U, Gai WP, Del Tredici K (2003) Idiopathic Parkinson’s disease: possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen. J Neural Transm 110:517–536PubMedCrossRefGoogle Scholar
  26. 26.
    Hirsch EC (2007) How to improve neuroprotection in Parkinson’s disease? Parkinsonism Relat Disord 13:S332–S335PubMedCrossRefGoogle Scholar
  27. 27.
    Findley LJ (2007) The economic impact of Parkinson’s disease. Parkinsonism Relat Disord 13(Suppl):S8–S12PubMedCrossRefGoogle Scholar
  28. 28.
    Fraix V, Houeto JL, Lagrange C et al (2006) Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:443–449PubMedCrossRefGoogle Scholar
  29. 29.
    Hempel AG, Wagner ML, Maaty MA, Sage JI (1998) Pharmacoeconomic analysis of using Sinemet CR over standard Sinemet in parkinsonian patients with motor fluctuations. Ann Pharmacother 32:878–883PubMedCrossRefGoogle Scholar
  30. 30.
    Lindgren P (2004) Economic evidence in Parkinson’s disease: a review. Eur J Health Econ 5(Suppl 1):S63–S66PubMedCrossRefGoogle Scholar
  31. 31.
    Noyes K, Dick AW, Holloway RG (2004) Pramipexole v levodopa as initial treatment for Parkinson’s disease: a randomized clinical-economic trial. Med Decis Making 24:472–485PubMedCrossRefGoogle Scholar
  32. 32.
    Wang G, Cheng Q, Zheng R et al (2006) Economic burden of Parkinson’s disease in a developing country: a retrospective cost analysis in Shanghai, China. Mov Disord 21:1439–1443PubMedCrossRefGoogle Scholar
  33. 33.
    Efron B, Tibshirani RJ (1994) An introduction to the bootstrap: (monographs on statistics and applied probablity). Chapman and Hall, LondonGoogle Scholar
  34. 34.
    Goldsworthy B, Knowles S (2008) Caregiving for Parkinson’s disease patients: an exploration of a stress-appraisal model for quality of life and burden. J Gerontol B Psychol Sci Soc Sci 63:P372–P376PubMedGoogle Scholar
  35. 35.
    Kim KS, Kim BJ, Kim KH et al (2007) Subjective and objective caregiver burden in Parkinson’s disease. Taehan Kanho Hakhoe Chi 37:242–248PubMedGoogle Scholar
  36. 36.
    Martinez-Martin P, Arroyo S, Rojo-Abuin JM, Rodriguez-Blazquez C, Frades B, de Pedro Cuesta J (2008) Burden, perceived health status, and mood among caregivers of Parkinson’s disease patients. Mov Disord 23:1673–1680PubMedCrossRefGoogle Scholar
  37. 37.
    Martinez-Martin P, Benito-Leon J, Alonso F et al (2005) Quality of life of caregivers in Parkinson’s disease. Qual Life Res 14:463–472PubMedCrossRefGoogle Scholar
  38. 38.
    Schrag A, Hovris A, Morley D, Quinn N, Jahanshahi M (2006) Caregiver-burden in Parkinson’s disease is closely associated with psychiatric symptoms, falls, and disability. Parkinsonism Relat Disord 12:35–41PubMedCrossRefGoogle Scholar
  39. 39.
    Spottke AE, Reuter M, Machat O et al (2005) Cost of illness and its predictors for Parkinson’s disease in Germany. Pharmacoeconomics 23:817–836PubMedCrossRefGoogle Scholar
  40. 40.
    Coyle D, Oakley J (2008) Estimating the expected value of partial perfect information: a review of methods. Eur J Health Econ 9:251–259PubMedCrossRefGoogle Scholar
  41. 41.
    Noyes K, Liu H, Temkin-Greener H (2006) Cost of caring for Medicare beneficiaries with Parkinson’s disease: impact of the CMS-HCC risk-adjustment model. Dis Manag 9:339–348PubMedCrossRefGoogle Scholar
  42. 42.
    Bryson HM, Milne RJ, Chrisp P (1992) Selegiline: an appraisal of the basis of its pharmacoeconomic and quality-of-life benefits in Parkinson’s disease. Pharmacoeconomics 2:118–136PubMedCrossRefGoogle Scholar
  43. 43.
    Hudry J, Rinne JO, Keranen T, Eckert L, Cochran JM (2006) Cost-utility model of rasagiline in the treatment of advanced Parkinson’s disease in Finland. Ann Pharmacother 40:651–657PubMedCrossRefGoogle Scholar
  44. 44.
    Iskedjian M, Einarson TR (2003) Cost analysis of ropinirole versus levodopa in the treatment of Parkinson’s disease. Pharmacoeconomics 21:115–127PubMedCrossRefGoogle Scholar
  45. 45.
    Noyes K, Dick AW, Holloway RG (2007) The implications of using US-specific EQ-5D preference weights for cost-effectiveness evaluation. Med Decis Making 27:327–334PubMedCrossRefGoogle Scholar
  46. 46.
    Palmer CS, Nuijten MJ, Schmier JK, Subedi P, Snyder EH (2002) Cost effectiveness of treatment of Parkinson’s disease with entacapone in the United States. Pharmacoeconomics 20:617–628PubMedCrossRefGoogle Scholar
  47. 47.
    Charles PD, Padaliya BB, Newman WJ et al (2004) Deep brain stimulation of the subthalamic nucleus reduces antiparkinsonian medication costs. Parkinsonism Relat Disord 10:475–479PubMedCrossRefGoogle Scholar
  48. 48.
    McIntosh E, Gray A, Aziz T (2003) Estimating the costs of surgical innovations: the case for subthalamic nucleus stimulation in the treatment of advanced Parkinson’s disease. Mov Disord 18:993–999PubMedCrossRefGoogle Scholar
  49. 49.
    Spottke EA, Volkmann J, Lorenz D et al (2002) Evaluation of healthcare utilization and health status of patients with Parkinson’s disease treated with deep brain stimulation of the subthalamic nucleus. J Neurol 249:759–766PubMedCrossRefGoogle Scholar
  50. 50.
    Valldeoriola F, Morsi O, Tolosa E, Rumia J, Marti MJ, Martinez-Martin P (2007) Prospective comparative study on cost-effectiveness of subthalamic stimulation and best medical treatment in advanced Parkinson’s disease. Mov Disord 22:2183–2191PubMedCrossRefGoogle Scholar
  51. 51.
    Berry RA, Murphy JF (1995) Well-being of caregivers of spouses with Parkinson’s disease. Clin Nurs Res 4:373–386PubMedCrossRefGoogle Scholar
  52. 52.
    Edwards NE, Ruettiger KM (2002) The influence of caregiver burden on patients’ management of Parkinson’s disease: implications for rehabilitation nursing. Rehabil Nurs 27:182–186, 198Google Scholar
  53. 53.
    Happe S, Berger K (2002) The association between caregiver burden and sleep disturbances in partners of patients with Parkinson’s disease. Age Ageing 31(5):349–354PubMedCrossRefGoogle Scholar
  54. 54.
    Reese SL (2007) Psychosocial factors in Parkinson’s disease. Dis Mon 53:291–295PubMedCrossRefGoogle Scholar
  55. 55.
    Teel CS, Press AN (1999) Fatigue among elders in caregiving and noncaregiving roles. West J Nurs Res 21:498–514; discussion 514–420Google Scholar
  56. 56.
    Vossius C, Nilsen OB, Larsen JP (2009) Parkinson’s disease and nursing home placement: the economic impact of the need for care. Eur J Neurol 16:194–200PubMedCrossRefGoogle Scholar
  57. 57.
    Martikainen KK, Luukkaala TH, Marttila RJ (2006) Parkinson’s disease and working capacity. Mov Disord 21:2187–2191PubMedCrossRefGoogle Scholar
  58. 58.
    Jennum P, Knudsen S, Kjeldberg J (2009) The economic consequences of narcolepsy. J Clin Sleep Med 5:240–245PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Poul Jennum
    • 1
    Email author
  • Marielle Zoetmulder
    • 1
    • 2
  • Lise Korbo
    • 2
  • Jakob Kjellberg
    • 3
  1. 1.Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Center for Healthy Aging, Faculty of Health SciencesUniversity of Copenhagen, Glostrup HospitalGlostrupDenmark
  2. 2.Department of NeurologyBispebjerg HospitalNV CopenhagenDenmark
  3. 3.Danish Institute for Health Services ResearchCopenhagenDenmark

Personalised recommendations