Skip to main content
Log in

Patient preferences and utilities for ‘off-time’ outcomes in the treatment of Parkinson's disease

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

The purpose of this study was to derive patient preferences and utilities for outcomes associated with treatment of motor fluctuations, or ‘off-time’ for patients with Parkinson's disease (PD). Visual analog scale (VAS) and standard gamble (SG) approaches were used with 60 patients to determine patient preferences and utilities for 10 health state descriptions. Health state descriptions were categorized according to two factors: disease severity, and proportion of the day with ‘off-time’. There were two representative levels of disease severity, based on Hoehn and Yahr stages 1.5 and 2.5: unilateral disease with no postural instability, and bilateral disease with some postural instability. These severity levels were combined with five levels of ‘off-time’ per day ranging from none to > 75% of the day. Patients' mean preference or utility for their own current health ranged from 0.65 ± 0.20 (VAS) to 0.74 ± 0.22 (SG). Patients assigned the lowest mean values to the health state description for Hoehn and Yahr stage 2.5 with ‘off-time’ for > 75% of the day (VAS: 0.17 ± 0.17; SG: 0.49 ± 0.27). The highest mean values were assigned to Hoehn and Yahr stage 1.5 with no ‘off-time’ (VAS: 0.83 ± 0.17; SG: 0.85 ± 0.18). The results of this study indicated patients with PD would likely seek treatment that would minimize the amount of ‘off-time’ experienced per day, and that patients were relatively risk averse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Eichhorn T, Oertel WH. Incidence, differential diagnosis, work capacity, mortality and cause of death in Parkinson disease. Versicherungsmedizin 1994; 46: 122–128.

    PubMed  CAS  Google Scholar 

  2. Tanner CM, Goldman SM. Epidemiology of Parkinson's disease. Neurol Clin 1996; 14:317–335.

    Article  PubMed  CAS  Google Scholar 

  3. Tapper VJ. Pathophysiology, assessment, and treatment of Parkinson's disease. Nurse Pract 1997; 22: 76–78.

    PubMed  CAS  Google Scholar 

  4. Kurth MC, Adler CH. COMT inhibition: A new treatment strategy for Parkinson's disease. Neurology 1998; 50: S3–S14.

    PubMed  CAS  Google Scholar 

  5. Marsden CD. Parkinson's disease. Lancet 1990; 335: 948–952.

    Article  PubMed  CAS  Google Scholar 

  6. Nutt JG, Holford NH. The response to levodopa in Par-kinson's disease: Imposing pharmacological law and order. Ann Neurol 1996; 39: 561–573.

    Article  PubMed  CAS  Google Scholar 

  7. Shale HM, Fahn S. Management of fluctuations in Par-kinson's disease. IM 1987; 8(3): 127–132.

    Google Scholar 

  8. Erwin WG, Turco TF. Current concepts in clinical thera-peutics: Parkinson's disease. Clin Pharm 1986; 5: 742–753.

    PubMed  CAS  Google Scholar 

  9. Baas H, Beiske AG, Ghika J, et al. Catechol-O-methyl-transferase inhibition with tolcapone reduces the “wearing off” phenomenon and levodopa requirements in fluctuating parkinsonian patients. Neurology 1998; 50: S46–S53.

    PubMed  CAS  Google Scholar 

  10. Marsden CD, Parkes JD. “On- off” effects in patients with Parkinson's disease on chronic levodopa therapy. Lancet 1976; 1: 292–296.

    Article  PubMed  CAS  Google Scholar 

  11. LeWitt PA. Treatment strategies for extension of levodopa effect. Neurol Clin 1992; 10: 511–526.

    PubMed  CAS  Google Scholar 

  12. Fitzpatrick R, Peto V, Jenkinson C, Greenhall R, Hyman N. Health-related quality of life in Parkinson's disease: A study of outpatient clinic attenders. Mov Disord 1997; 12: 916–922.

    Article  PubMed  CAS  Google Scholar 

  13. Chrischilles EA, Rubenstein LM, Voelker MD, Wallace RB, Rodnitzky RL. The health burdens of Parkinson's disease. Mov Disord 1998; 13: 406–413.

    Article  PubMed  CAS  Google Scholar 

  14. Longstreth WT, Jr., Nelson L, Linde M, Munoz D. Utility of the sickness impact profile in Parkinson's disease. J Geriatr Psychiatry Neurol 1992; 5: 142–148.

    PubMed  Google Scholar 

  15. Shindler JS, Brown R, Welburn P, Parkes JD. Measuring the quality of life of patients with Parkinson's disease. In: Walker SR, Rosser RM (eds), Quality of Life Assessment: Key Issues in the 1990s, Boston, MA: Kluwer Academic Publishers, 1993: 289–300.

    Google Scholar 

  16. Brod M, Mendelsohn GA, Roberts B. Patients' experiences of Parkinson's disease. J Gerontol B Psychol Sci Soc Sci 1998; 53(4): 213–222.

    Google Scholar 

  17. Torrance GW, Feeny D. Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989; 5: 559–575.

    Article  PubMed  CAS  Google Scholar 

  18. Gold MR, Patrick DL, Torrance GW, et al. Identifying and valuing outcomes. In: Gold MR, Siegel JE, Russell LB, Weinstein MC (eds) Cost-effectiveness in Health and Medicine, NY: Oxford University Press, 1996: 115.

    Google Scholar 

  19. Furlong W, Feeny D, Torrance GW. Guide to Design and Development of Health State Utility Instrumentation. Hamilton, Ontario: McMaster University, 1990: 11, 23–25.

    Google Scholar 

  20. von Neumann J, Morgenstern O. Theory of Games and Economic Behavior. 2nd edn. Princeton, NJ: Princeton University Press, 1947.

    Google Scholar 

  21. Torrance GW. Measurement of health state utilities for economic appraisal. J Health Econ 1986; 5: 1–30.

    Article  PubMed  CAS  Google Scholar 

  22. Hoehn MM, Yahr MD. Parkinsonism: Onset, progression, and mortality. Neurology 1967; 17: 427–442.

    Article  PubMed  CAS  Google Scholar 

  23. Lang A, Fahn S. Assessment of Parkinson's disease. In: Munsat TL (ed), Quantification of Neurologic Deficit. Stoneham, MA: Butterworth, 1986: 285–309.

    Google Scholar 

  24. Lang AE. Clinical rating scales and videotape analysis. In: Koller WC (ed), Therapy of Parkinson's Disease. New York: Marcel Dekker, 1995: 21–42.

    Google Scholar 

  25. Martinez-Martin P, Gil-Nagel A, Gracia LM, Gomez JB, Martinez-Sarries J, Bermejo F. Unified Parkinson's Disease Rating Scale characteristics and structure. The Cooperative Multicentric Group. Mov Disord 1994; 9: 76–83.

    CAS  Google Scholar 

  26. Martinez-Martin P. Rating scales in Parkinson's disease. In: Jankovic J, Tolosa E (eds), Parkinson's Disease and Movement Disorders. Baltimore: Williams & Wilkins, 1993: 281–288.

    Google Scholar 

  27. Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA: The Health Institute, New England Medical Center, 1993: Chapters 7- 10.

    Google Scholar 

  28. Rubenstein LM, Voelker MD, Chrischilles EA, Glenn DC, Wallace RB, Rodnitzky RL. The usefulness of the Func-tional Status Questionnaire and Medical Outcomes Study Short Form in Parkinson's disease research. Qual Life Res 1998; 7: 279–290.

    PubMed  CAS  Google Scholar 

  29. Jenkinson C, Peto V, Fitzpatrick R, Greenhall R, Hyman N. Self-reported functioning and well-being in patients with Parkinson's disease: Comparison of the Short-Form Health Survey (SF-36) and the Parkinson's Disease Questionnaire (PDQ-39). Age Ageing 1995; 24: 505–509.

    PubMed  CAS  Google Scholar 

  30. Nease RF, Jr., Kneeland T, O'Connor GT, et al. Variation in patient utilities for outcomes of the management of chronic stable angina. JAMA 1995; 273: 1185–1190.

    Article  PubMed  Google Scholar 

  31. Revicki DA. Relationship between health utility and psy-chometric health status measures. Med Care 1992; 30: MS274–MS282.

    PubMed  CAS  Google Scholar 

  32. Revicki DA. Measuring health outcomes for cost-effec-tiveness studies: Are all quality adjusted life years created equal? Drug Inf J 1995; 29: 1461–1467.

    Google Scholar 

  33. Rutten-van Molken MP, Bakker CH, van Doorslaer EK, van der Linden S. Methodological issues of patient utility measurement. Experience from two clinical trials. Med Care 1995; 33: 922–937.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Palmer, C.S., Schmier, J.K., Snyder, E. et al. Patient preferences and utilities for ‘off-time’ outcomes in the treatment of Parkinson's disease. Qual Life Res 9, 819–827 (2000). https://doi.org/10.1023/A:1008903126315

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1008903126315

Navigation