Drugs & Aging

, Volume 23, Issue 9, pp 693–721 | Cite as

A Review of the Health-Related Quality of Life and Economic Impact of Parkinson’s Disease

  • Clare H. Dowding
  • Claire L. Shenton
  • Sam S. SalekEmail author
Review Article


Parkinson’s disease (PD) is a chronic, neurodegenerative disease that places a substantial burden on patients, their families and carers, as well as on society as a whole. PD can severely affect the health-related quality of life (HR-QOL) of both patients and their carers and, as the disease progresses, HR-QOL deteriorates. This review aims to critically evaluate the literature on a number of important aspects that influence HR-QOL in relation to PD. Factors associated with a negative impact and ways to improve HR-QOL are highlighted, and tools for HR-QOL assessment reviewed. The economic impact of PD and related cost-effectiveness studies are also reviewed.

Over the course of the disease, patients with PD experience changes in their HR-QOL that are affected by factors such as depression, motor complications, education and surgery. However, a lack of uniformity in the choice of HR-QOL tools used in studies makes comparison of results difficult. Research on motor fluctuations and dyskinesias has shown conflicting results, whereas it is clear from the available data that depression needs to be more clearly recognised and treated. Inequality in the numbers of men and women receiving surgery still needs to be addressed and, again, in this area there is a lack of uniformity with respect to assessment for surgery. Education programmes have been shown to be successful in improving HR-QOL, although more research is needed about how to introduce such programmes to all PD patients. In particular, there has been little detailed research into young-onset PD and juvenile patients to assess the true impact of the disease on their HR-QOL.

The literature has also shown that PD can affect the HR-QOL of the carer, which may have a ‘knock-on’ effect for the patient. The HR-QOL of carers needs more attention because these individuals can significantly reduce the burden that would otherwise fall on the health services in terms of cost and care.

Research shows that the economic costs of PD are high, particularly for patients in advanced stages of the disease and those with motor complications. Although carer burden is a major source of costs, this is not factored into cost-effectiveness analyses. Furthermore, because too few studies use quality-adjusted life years as their health outcome, particularly in studies of the costs of surgery, comparison of costs of treatments is difficult. The review highlights the need for HR-QOL tools such as the EuroQol-5D to be used together with disease-specific tools to provide the most comprehensive picture of the costs and impact of PD.

A recent upsurge in published literature on PD resulting from increased interest in HR-QOL issues has led to an at times overwhelming amount of new information. The present review assembles the most important points relating to HR-QOL in PD raised in the literature, adds value to previously covered issues, and examines areas of HR-QOL in PD that have not previously been reviewed, such as education, carer burden and surgery, highlighting where more research is warranted.


Motor Fluctuation Nottingham Health Profile Motor Complication Sickness Impact Profile 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.


  1. 1.
    Samii A, Nutt JG, Ransom BR. Parkinson’s disease. Lancet 2004 May; 363(9423): 1783–93PubMedCrossRefGoogle Scholar
  2. 2.
    Martinez-Martin P. An introduction to the concept of “quality of life in Parkinson’s disease”. J Neurol 1998 May; 245: S2–6PubMedCrossRefGoogle Scholar
  3. 3.
    Ebrahim S. Clinical and public health perspectives and applications of health-related quality of life measurement. Soc Sci Med 1995; 41(10): 1383–94PubMedCrossRefGoogle Scholar
  4. 4.
    Dolan P. Valuing health-related quality of life: issues and controversies. Pharmacoeconomics 1998; 15(2): 119–27CrossRefGoogle Scholar
  5. 5.
    Damiano AM, Snyder C, Strausser B, et al. A review of health-related quality of life concepts and measures for Parkinson’sdisease. Qual Life Res 1999; 8(3): 235–43PubMedCrossRefGoogle Scholar
  6. 6.
    Marinus J, Ramaker C, van Hilten JJ, et al. Health related quality of life in Parkinson’s disease: a systematic review of disease specific instruments. J Neurol Neurosurg Psychiatry 2002 Feb; 72(2): 241–8PubMedCrossRefGoogle Scholar
  7. 7.
    Dodel RC, Berger K, Oertel WH. Health-related quality of life and healthcare utilisation in patients with Parkinson’s disease. Pharmacoeconomics 2001; 19(10): 1013–38PubMedCrossRefGoogle Scholar
  8. 8.
    Rubenstein LM, deLeo A, Chrischilles EA. Economic and health-related quality of life considerations of new therapies in Parkinson’s disease. Pharmacoeconomics 2001; 19(7): 729–52PubMedCrossRefGoogle Scholar
  9. 9.
    Brouwer WBF. Too important to ignore: informal caregivers and other significant others. Pharmacoeconomics 2006; 24(1): 39–41PubMedCrossRefGoogle Scholar
  10. 10.
    The EuroQol Group. EuroQoL: a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208CrossRefGoogle Scholar
  11. 11.
    Schrag A, Selai C, Jahanshahi M, et al. The EQ-5D: a generic quality of life measure: is a useful instrument to measure quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2000; 69: 67–73PubMedCrossRefGoogle Scholar
  12. 12.
    Tan LCS, Luo N, Nazri M, et al. Validity and reliability of the PDQ-39 and the PDQ-8 in English-speaking Parkinson’s disease patients in Singapore. Parkinsonism Relat Disord 2004; 10(8): 493–9PubMedCrossRefGoogle Scholar
  13. 13.
    Jenkinson C, Fitzpatrick R, Peto V. Health-related quality of life measurement in patients with Parkinson’s disease. Pharmacoeconomics 1999; 15(2): 157–65PubMedCrossRefGoogle Scholar
  14. 14.
    Ali T. Validation of patient-reported outcomes in Parkinson’s disease: comparisons of generic and disease-specific health-related quality of life instruments [Ph.D. thesis]. Cardiff: Cardiff University, 2005Google Scholar
  15. 15.
    Longstreth WTJ, Nelson L, Linde M, et al. Utility of the Sickness Impact Profile in Parkinson’s disease. J Geriatr Psychiatry Neurol 1992; 5(3): 142–8PubMedGoogle Scholar
  16. 16.
    Brazier JE, Harper R, Jones NMB, et al. Validating the SF-36Health Survey Questionnaire - new outcome measure for primary care. BMJ 1992 Jul 18; 305(6846): 160–4PubMedCrossRefGoogle Scholar
  17. 17.
    Hobson JP, Meara RJ. Is the SF-36 Health Survey questionnaire suitable as a self-report measure of the health status of older adults with Parkinson’s disease? Qual Life Res 1997 Apr; 6(3): 213–6PubMedCrossRefGoogle Scholar
  18. 18.
    Jenkinson C, Peto V, Fitzpatrick R, et al. 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 Nov; 24(6): 505–9PubMedCrossRefGoogle Scholar
  19. 19.
    Hagell P, Whalley D, McKenna SP, et al. Health status measurement in Parkinson’s disease: validity of the PDQ-39 and Nottingham Health Profile. Mov Disord 2003 Jul; 18(7): 773–83PubMedCrossRefGoogle Scholar
  20. 20.
    Karlsen KH, Larsen JP, Tandberg E, et al. Quality of life measurements in patients with Parkinson’s disease: a community-based study. Eur J Neurol 1998; 5: 443–50PubMedCrossRefGoogle Scholar
  21. 21.
    Peto V, Jenkinson C, Fitzpatrick R. PDQ-39: a review of the development, validation and application of a Parkinson’s disease quality of life questionnaire and its associated measures. J Neurol 1998 May; 245: S10–S4PubMedCrossRefGoogle Scholar
  22. 22.
    Jenkinson C, Fitzpatrick R, Peto V, et al. The Parkinson’s Disease Questionnaire (PDQ-39): development and validation of a Parkinson’s disease summary index score. Age Ageing 1997 Sep; 26(5): 353–7PubMedCrossRefGoogle Scholar
  23. 23.
    Katsarou Z, Bostantjopoulou S, Peto V, et al. Assessing quality of life in Parkinson’s disease: can a short-form questionnaire be useful? Mov Disord 2004; 19(3): 308–12PubMedCrossRefGoogle Scholar
  24. 24.
    Hobson P, Holden A, Meara J. Measuring the impact of Parkinson’s disease with the Parkinson’s Disease Quality of Life Questionnaire. Age Ageing 1999 Jul; 28(4): 341–6PubMedCrossRefGoogle Scholar
  25. 25.
    Serrano-Duenas M, Martinez-Martin P, Vaca-Baquero V. Validation and cross-cultural adjustment of PDQL-questionnaire, Spanish version (Ecuador) (PDQL-EV). Parkinsonism Relat Disord 2004 Oct; 10(7): 433–7PubMedCrossRefGoogle Scholar
  26. 26.
    Calne S, Schulzer M, Mak E, et al. Validating a quality of life rating scale for idiopathic parkinsonism: Parkinson’s Impact Scale (PIMS). Parkinsonism Relat Disord 1996; 2(2): 55–61PubMedCrossRefGoogle Scholar
  27. 27.
    Schulzer M, Mak E, Calne SM. The psychometric properties of the Parkinson’s Impact Scale (PIMS) as a measure of quality of life in Parkinson’s disease. Parkinsonism Relat Disord 2003; 9: 291–4PubMedCrossRefGoogle Scholar
  28. 28.
    Welsh M, McDermott MP, Holloway RG, et al. Development and testing of the Parkinson’s Disease Quality of Life Scale. Mov Disord 2003; 18(6): 637–45PubMedCrossRefGoogle Scholar
  29. 29.
    Karlsen KH, Tandberg E, Arsland D, et al. Health related quality of life in Parkinson’s disease: a prospective longitudinal study. J Neurol Neurosurg Psychiatry 2000; 69: 584–9PubMedCrossRefGoogle Scholar
  30. 30.
    Fahn S, Elton R. Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden C, Goldstein M, Calne D, editors. Recent developments in Parkinson’s disease. Florham Park (NJ): Macmillan Healthcare Information, 1987: 153–63Google Scholar
  31. 31.
    Hoehn M, Yahr M. Parkinsonism: onset, progression and mortality. Neurology 1967; 17: 427–42PubMedCrossRefGoogle Scholar
  32. 32.
    Beck A, Ward C, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–71PubMedCrossRefGoogle Scholar
  33. 33.
    Schwab R, England A. Projection technique for evaluating surgery in Parkinson’s disease. In: Gillingham F, Donaldson I, editors. Third symposium on surgery in Parkinson’s disease. Edinburgh: Livingstone, 1969: 152–7Google Scholar
  34. 34.
    Folstein M, Folstein S, McHugh P. Mini-Mental State, a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98PubMedCrossRefGoogle Scholar
  35. 35.
    Lyons RA, Perry HM, Littlepage BNC. Evidence for the validity of the Short-Form-36 Questionnaire (SF-36) in an elderly population. Age Ageing 1994 May; 23(3): 182–4PubMedCrossRefGoogle Scholar
  36. 36.
    Kuopio A, Marttila RJ, Helenius H, et al. The quality of life in Parkinson’s disease. Mov Disord 2000; 15(2): 216–23PubMedCrossRefGoogle Scholar
  37. 37.
    Jenkinson C, Fitzpatrick R, Argyle M. The Nottingham-Health-Profile: an analysis of its sensitivity in differentiating illness groups. Soc Sci Med 1988; 27(12): 1411–4PubMedCrossRefGoogle Scholar
  38. 38.
    Karlsen KH, Larsen JP, Tandberg E, et al. Influence of clinical and demographic variables on quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999 Apr; 66(4): 431–5PubMedCrossRefGoogle Scholar
  39. 39.
    Martinez-Martin P, Payo BF. Quality of life in Parkinson’s disease: validation study of the PDQ-39 Spanish version. J Neurol 1998 May; 245: S34–S8PubMedCrossRefGoogle Scholar
  40. 40.
    Bushnell DM, Martin ML. Quality of life and Parkinson’s disease: translation and validation of the US Parkinson’s Disease Questionnaire (PDQ-39). Qual Life Res 1999 Jun; 8(4): 345–50PubMedCrossRefGoogle Scholar
  41. 41.
    deBoer A, Wijker W, Speelman JD, et al. Quality of life in patients with Parkinson’s disease: development of a questionnaire. J Neurol Neurosurg Psychiatry 1996 Jul; 61(1): 70–4CrossRefGoogle Scholar
  42. 42.
    Schrag A, Ben-Shlomo Y, Brown R, et al. Young-onset Parkinson’s disease revisited: clinical features, natural history, and mortality. Mov Disord 1998 Nov; 13(6): 885–94PubMedCrossRefGoogle Scholar
  43. 43.
    Schrag A, Hovris A, Morley D, et al. Young versus older-onset Parkinson’s disease: impact of disease and psychosocial consequences. Mov Disord 2003 Nov; 18(11): 1250–6PubMedCrossRefGoogle Scholar
  44. 44.
    Shulman LM, Minagar A, Weiner WJ. The effect of pregnancy in Parkinson’s disease. Mov Disord 2000 Jan; 15(1): 132–5PubMedCrossRefGoogle Scholar
  45. 45.
    Chapuis S, Ouchchane L, Metz O, et al. Impact of the motor complications of Parkinson’s disease on the quality of life. Mov Disord 2005; 20(2): 224–30PubMedCrossRefGoogle Scholar
  46. 46.
    Damiano AM, McGrath MM, Willian MK, et al. Evaluation of a measurement strategy for Parkinson’s disease: Assessing patient health-related quality of life. Qual Life Res 2000; 9(1): 87–100PubMedCrossRefGoogle Scholar
  47. 47.
    Marras C, Lang A, Krahn M, et al. Quality of life in early Parkinson’s disease: impact of dyskinesias and motor fluctuations. Mov Disord 2004; 19(1): 22–8PubMedCrossRefGoogle Scholar
  48. 48.
    Zach M, Friedman A, Slawek J, et al. Quality of life in Polish patients with long-lasting Parkinson’s disease. Mov Disord 2004 Jun; 19(6): 667–72PubMedCrossRefGoogle Scholar
  49. 49.
    Schrag A, Jahanshahi M, Quinn N. What contributes to quality of life in patients with Parkinson’s disease? J Neurol Neurosurg Psychiatry 2000; 69: 308–12PubMedCrossRefGoogle Scholar
  50. 50.
    Pechevis M, Clarke CE, Vieregge P, et al. Effects of dyskinesias in Parkinson’s disease on quality of life and health-related costs: a prospective European study. Eur J Neurol 2005 Dec; 12(12): 956–63PubMedCrossRefGoogle Scholar
  51. 51.
    Just H, Ostergaard K. Health-related quality of life in patients with advanced Parkinson’s disease treated with deep brain stimulation of the subthalamic nuclei. Mov Disord 2002 May; 17(3): 539–45PubMedCrossRefGoogle Scholar
  52. 52.
    Olanow CW, Agid Y, Mizuno Y, et al. Levodopa in the treatment of Parkinson’s disease: current controversies. Mov Disord 2004 Sep; 19(9): 997–1005PubMedCrossRefGoogle Scholar
  53. 53.
    Calne SM. The psychosocial impact of late-stage Parkinson’s disease. J Neurosci Nurs 2003 Dec; 35(6): 306–13PubMedCrossRefGoogle Scholar
  54. 54.
    Chung TH, Deane KHO, Ghazi-Noori S, et al. Systematic review of antidepressant therapies in Parkinson’s disease. Parkinsonism Relat Disord 2003; 10: 59–65PubMedCrossRefGoogle Scholar
  55. 55.
    Caap-Ahlgren M, Dehlin O. Insomnia and depressive symptoms in patients with Parkinson’s disease. Relationship to health-related quality of life. An interview study of patients living at home. Arch Gerontol Geriatr 2001; 32: 23–33PubMedCrossRefGoogle Scholar
  56. 56.
    Findley L, Eichhorn T, Janca A, et al. Factors impacting on quality of life in Parkinson’s disease: results from an international survey. Mov Disord 2002 Jan; 17(1): 60–7CrossRefGoogle Scholar
  57. 57.
    Lemke MR, Fuchs G, Gemende I, et al. Depression and Parkinson’s disease. J Neurol 2004; 251Suppl. 6: VI/24–VI/7Google Scholar
  58. 58.
    Behari M, Srivastava AK, Pandey RM. Quality of life in patients with Parkinson’s disease. Parkinsonism Relat Disord 2005; 11: 221–6PubMedCrossRefGoogle Scholar
  59. 59.
    Holroyd S, Currie LJ, Wooten GF. Depression is associated with impairment of ADL, not motor function in Parkinson disease. Neurology 2005 Jun; 64: 2134–5PubMedCrossRefGoogle Scholar
  60. 60.
    Slawek J, Derejko M, Lass P. Factors affecting the quality of life of patients with idiopathic Parkinson’s disease: a cross-sectional study in an outpatient clinic attendees. Parkinsonism Relat Disord 2005 Nov; 11(7): 465–8PubMedCrossRefGoogle Scholar
  61. 61.
    Leentjens AF, Verhey FR, Luijckx GJ, et al. The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson’s disease. Mov Disord 2000 Nov; 15(6): 1221–4PubMedCrossRefGoogle Scholar
  62. 62.
    Leentjens AF, Verhey FR, Lousberg R, et al. The validity of the Hamilton and Montgomery-Asberg depression rating scales as screening and diagnostic tools for depression in Parkinson’s disease. Int J Geriatr Psychiatry 2000 Jul; 15(7): 644–9PubMedCrossRefGoogle Scholar
  63. 63.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  64. 64.
    Meara J, Mitchelmore E, Hobson P. Use of the GDS-15 geriatric depression scale as a screening instrument for depressive symptomatology in patients with Parkinson’s disease and their carers in the community. Age Ageing 1999 Jan; 28(1): 35–8PubMedCrossRefGoogle Scholar
  65. 65.
    Playfer JR. Depression, cognition and quality of life in parkinsonian patients. Age Ageing 1999; 28: 333–4PubMedCrossRefGoogle Scholar
  66. 66.
    Kanner AM. Should neurologists be trained to recognize and treat comorbid depression of neurologic disorders? Yes. Epilepsy Behav 2005 May; 6(3): 303–11PubMedCrossRefGoogle Scholar
  67. 67.
    Lezcano E, Gomez-Esteban JC, Zarranz JJ, et al. Improvement in quality of life in patients with advanced Parkinson’s disease following bilateral deep-brain stimulation in subthalamic nucleus. Eur J Neurol 2004; 11: 451–4PubMedCrossRefGoogle Scholar
  68. 68.
    Defer GL, Widner H, Marie RM, et al. Core assessment program for surgical interventional therapies in Parkinson’s disease (CAPSIT-PD). Mov Disord 1999 Jul; 14(4): 572–84PubMedCrossRefGoogle Scholar
  69. 69.
    Hagell P, Crabb L, Pogarell O, et al. Health-related quality of life following bilateral intrastriatal transplantation in Parkinson’s disease. Mov Disord 2000 Mar; 15(2): 224–9PubMedCrossRefGoogle Scholar
  70. 70.
    Straits-Troster K, Fields JA, Wilkinson SB, et al. Health-related quality of life in Parkinson’s disease after pallidotomy and deep brain stimulation. Brain Cogn 2000; 42: 399–416PubMedCrossRefGoogle Scholar
  71. 71.
    Martinez-Martin P, Valldeoriola F, Molinuevo JL, et al. Pallidotomy and quality of life in patients with Parkinson’s disease: an early study. Mov Disord 2000 Jan; 15(1): 65–70PubMedCrossRefGoogle Scholar
  72. 72.
    Gray A, McNamar I, Aziz T, et al. Quality of life outcomes following surgical treatment of Parkinson’s disease. Mov Disord 2002; 17(1): 68–75PubMedCrossRefGoogle Scholar
  73. 73.
    Scott R, Gregory R, Hines N, et al. Neuropsychological, neurological and functional outcome following pallidotomy for Parkinson’s disease: a consecutive series of eight simultaneous bilateral and twelve unilateral procedures. Brain 1998 Apr; 121: 659–75PubMedCrossRefGoogle Scholar
  74. 74.
    Drapier S, Raoul S, Drapier D, et al. Only physical aspects of quality of life are significantly improved by bilateral sub-thalamic stimulation in Parkinson’s disease. J Neurol 2005; 252: 583–8PubMedCrossRefGoogle Scholar
  75. 75.
    Siderowf A, Jaggi JL, Xie SX, et al. Long-term effects of bilateral subthalamic nucleus stimulation on health-related quality of life in advanced Parkinson’s disease. Mov Disord, Epub 2006 Feb 6Google Scholar
  76. 76.
    Martinez-Martin P, Valldeoriola F, Tolosa E, et al. Bilateral subthalamic nucleus stimulation and quality of life in advanced Parkinson’s disease. Mov Disord 2002 Mar; 17(2): 372–7PubMedCrossRefGoogle Scholar
  77. 77.
    Vingerhoets G, Lannoo E, Van der Linden C, et al. Changes in quality of life following unilateral pallidal stimulation in Parkinson’s disease. J Psychosom Res 1999; 46(3): 247–55PubMedCrossRefGoogle Scholar
  78. 78.
    Spottke EA, Volkmann J, Lorenz D, et al. Evaluation of healthcare utilization and health status of patients with Parkinson’s disease treated with deep brain stimulation of the subthalamic nucleus. J Neurol 2002 Jun; 249(6): 759–66PubMedCrossRefGoogle Scholar
  79. 79.
    Esselink RA, de Bie RM, de Haan RJ, et al. Unilateral pallidoto-my versus bilateral subthalamic nucleus stimulation in PD: a randomized trial. Neurology 2004 Jan 27; 62(2): 201–7PubMedCrossRefGoogle Scholar
  80. 80.
    Erola T, Karinen P, Heikkinen E, et al. Bilateral subthalamic nucleus stimulation improves health-related quality of life in parkinsonian patients. Parkinsonism Relat Disord 2005; 11: 89–94PubMedCrossRefGoogle Scholar
  81. 81.
    Daniele A, Albanese A, Contarino MF, et al. Cognitive and behavioural effects of chronic stimulation of the subthalamic nucleus in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2003 Feb; 74(2): 175–82PubMedCrossRefGoogle Scholar
  82. 82.
    Lagrange E, Krack P, Moro E, et al. Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD. Neurology 2002 Dec 24; 59(12): 1976–8PubMedCrossRefGoogle Scholar
  83. 83.
    Patel NK, Plaha P, O’Sullivan K, et al. MRI directed bilateral stimulation of the subthalamic nucleus in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2003 Dec; 74(12): 1631–7PubMedCrossRefGoogle Scholar
  84. 84.
    McRae C, Cherin E, Yamazaki TG, et al. Effects of perceived treatment on quality of life and medical outcomes in a double-blind placebo surgery trial. Arch Gen Psychiatry 2004; 61: 412–20PubMedCrossRefGoogle Scholar
  85. 85.
    Croyle KL, Tröster AI, Fields JA, et al. Presurgical coping, depression, and quality of life in persons with Parkinson’s disease. J Clin Psychol Med Settings 2003 Jun; 10(2): 101–7CrossRefGoogle Scholar
  86. 86.
    Hariz GM, Lindberg M, Hariz MI, et al. Gender differences in disability and health-related quality of life in patients with Parkinson’s disease treated with stereotactic surgery. Acta Neurol Scand 2003; 108: 28–37PubMedCrossRefGoogle Scholar
  87. 87.
    Kuehler A, Henrich G, Schroeder U, et al. A novel quality of life instrument for deep brain stimulation in movement disorders. J Neurol Neurosurg Psychiatry 2003; 74: 1023–30PubMedCrossRefGoogle Scholar
  88. 88.
    Montgomery EB, Lieberman A, Singh G, et al. Patient education and health promotion can be effective in Parkinson’s disease: a randomized controlled trial. Am J Med 1994 Nov; 97(5): 429–35PubMedCrossRefGoogle Scholar
  89. 89.
    Shimbo T, Goto M, Morimoto T, et al. Association between patient education and health-related quality of life in patients with Parkinson’s disease. Qual Life Res 2004; 13(1): 81–9PubMedCrossRefGoogle Scholar
  90. 90.
    Sunvisson H, Ekman SL, Hagberg H, et al. An education programme for individuals with Parkinson’s disease. Scand J Caring Sci 2001; 15(4): 311–7PubMedCrossRefGoogle Scholar
  91. 91.
    Ward CD, Turpin G, Dewey ME, et al. Education for people with progressive neurological conditions can have negative effects: evidence from a randomized controlled trial. Clin Rehabil 2004 Nov; 18(7): 717–25PubMedCrossRefGoogle Scholar
  92. 92.
    Mercer BS. Randomized study of the efficacy of the PROPATH program for patients with Parkinson disease. Arch Neurol 1996 Sep; 53(9): 881–4PubMedCrossRefGoogle Scholar
  93. 93.
    Cubo E, Rojo A, Ramos S, et al. The importance of educational and psychological factors in Parkinson’s disease quality of life. Eur J Neurol 2002; 9: 589–93PubMedCrossRefGoogle Scholar
  94. 94.
    Rocca WA, Anderson DW, Meneghini F, et al. Occupation, education, and Parkinson’s disease: a case-control study in an Italian population. Mov Disord 1996 Mar; 11(2): 201–6PubMedCrossRefGoogle Scholar
  95. 95.
    Pai MC, Chan SH. Education and cognitive decline in Parkinson’s disease: a study of 102 patients. Acta Neurol Scand 2001 Apr; 103(4): 243–7PubMedCrossRefGoogle Scholar
  96. 96.
    Martinez-Martin P, Benito-Leon J, Alonso F, et al. Quality of life of caregivers in Parkinson’s disease. Qual Life Res 2005 Mar; 14(2): 463–72PubMedCrossRefGoogle Scholar
  97. 97.
    Calder SA, Ebmeier KP, Stewart L, et al. The prediction of stress in carers: the role of behaviour, reported self-care and dementia in patients with idiopathic Parkinson’s disease. Int J Geriatr Psychiatr 1991 Oct; 6(10): 737–42CrossRefGoogle Scholar
  98. 98.
    Glozman JM, Bicheva KG, Fedorova NV. Scale of Quality of Life of Caregivers (SQLC). J Neurol 1998 May; 245: S39–41PubMedCrossRefGoogle Scholar
  99. 99.
    Dixon S, Walker M, Salek S. Incorporating carer effects into economic evaluation. Pharmacoeconomics 2006; 24(1): 43–53PubMedCrossRefGoogle Scholar
  100. 100.
    McRae C, Sherry P, Roper K. Stress and family functioning among caregivers of persons with Parkinson’s disease. Parkinsonism Relat Disord 1999; 5: 69–75PubMedCrossRefGoogle Scholar
  101. 101.
    Carter JH, Stewart BJ, Archbold PG, et al. Living with a person who has Parkinson’s disease: the spouse’s perspective by stage of disease. Mov Disord 1998 Jan; 13(1): 20–8PubMedCrossRefGoogle Scholar
  102. 102.
    Keranen T, Kaakkola S, Sotaniemi K, et al. Economic burden and quality of life impairment increase with severity of PD. Parkinsonism Relat Disord 2003; 9: 163–8PubMedCrossRefGoogle Scholar
  103. 103.
    McGuigan S. Compendium of health statistics. London: Office of Health Economics, 1997Google Scholar
  104. 104.
    Prevalence of treated hypertension per 1000 patients, by age, sex and calendar year: 1994–98. Newport: Office for National Statistics [online]. Available from URL: [Accessed 2006 Sep 18]
  105. 105.
    Prevalence of treated asthma per 1000 patients, by age, sex and calendar year: 1994–98. Newport: Office for National Statistics [online]. Available from URL: [Accessed 2006 Sep 18]
  106. 106.
    Frequently asked questions (FAQs): who gets Parkinson’s? London: Parkinson’s Disease Society, 2006 [online]. Available from URL: [Accessed 2006 Apr 10]
  107. 107.
    Schiefe RT, Schumock GT, Burstein A, et al. Impact of Parkinson’s disease and its pharmacologic treatment on quality of life and economic outcomes. Am J Health Syst Pharm 2000; 57: 953–62Google Scholar
  108. 108.
    Findley L, Aujla M, Bain PG, et al. Direct economic impact of Parkinson’s disease: a research survey in the United Kingdom. Mov Disord 2003 Oct; 18(10): 1139–45PubMedCrossRefGoogle Scholar
  109. 109.
    Dodel RC, Singer M, Kohne-Volland R, et al. The economic impact of Parkinson’s disease: an estimation based on a 3-month prospective analysis. Pharmacoeconomics 1998 Sep; 14(3): 299–312PubMedCrossRefGoogle Scholar
  110. 110.
    Shimbo T, Hira K, Takemura M, et al. Cost-effectiveness analysis of dopamine agonists in the treatment of Parkinson’s disease in Japan. Pharmacoeconomics 2001; 19(8): 875–86PubMedCrossRefGoogle Scholar
  111. 111.
    Dodel RC, Eggert KM, Singer MS, et al. Costs of drug treatment in Parkinson’s disease. Mov Disord 1998 Mar; 13(2): 249–54PubMedCrossRefGoogle Scholar
  112. 112.
    Siderowf AD, Holloway RG, Stern MB. Cost-effectiveness analysis in Parkinson’s disease: determining the value of interventions. Mov Disord 2000; 15(3): 439–45PubMedCrossRefGoogle Scholar
  113. 113.
    Charles PD, Padaliya BB, Newman WJ, et al. Deep brain stimulation of the subthalamic nucleus reduces antiparkinsonian medication costs. Parkinsonism Relat Disord 2004 Dec; 10(8): 475–9PubMedCrossRefGoogle Scholar
  114. 114.
    McIntosh E, Gray A, Aziz T. Estimating the costs of surgical innovations: the case for subthalamic nucleus stimulation in the treatment of advanced Parkinson’s disease. Mov Disord 2003 Sep; 18(9): 993–9PubMedCrossRefGoogle Scholar
  115. 115.
    Meissner W, Schreiter D, Volkmann J, et al. Deep brain stimulation in late stage Parkinson’s disease: a retrospective cost analysis in Germany. J Neurol 2005 Feb; 252(2): 218–23PubMedCrossRefGoogle Scholar
  116. 116.
    Tomaszewski KJ, Holloway RG. Deep brain stimulation in the treatment of Parkinson’s disease: a cost-effectiveness analysis. Neurology 2001 Aug 28; 57(4): 663–71PubMedCrossRefGoogle Scholar
  117. 117.
    Green AL, Joint C, Sethi H, et al. Cost analysis of unilateral and bilateral pallidotomy for Parkinson’s disease. J Clin Neurosci 2004 Nov; 11(8): 829–34PubMedCrossRefGoogle Scholar
  118. 118.
    Palmer CS, Nuijten MJC, Schmier JK, et al. Cost effectiveness of treatment of Parkinson’s disease with entacapone in the United States. Pharmacoeconomics 2002; 20(9): 614–28CrossRefGoogle Scholar
  119. 119.
    Nuijten MJC, van Iperen P, Palmer C, et al. Cost-effectiveness analysis of entacapone in Parkinson’s disease: a Markov process analysis. Value Health 2001; 4(4): 316–28PubMedGoogle Scholar
  120. 120.
    Hoerger TJ, Bala MV, Rowland C, et al. Cost-effectiveness of pramipexole in Parkinson’s disease in the US. Pharmacoeconomics 1998; 14(5): 541–57PubMedCrossRefGoogle Scholar
  121. 121.
    Noyes K, Dick AW, Holloway RG. Pramipexole and levodopa in early Parkinson’s disease: dynamic changes in cost effectiveness. Pharmacoeconomics 2005; 23(12): 1257–70PubMedCrossRefGoogle Scholar
  122. 122.
    Hempel AG, Wagner ML, Maaty MA, et al. Pharmacoeconomic analysis of using Sinemet CR over standard Sinemet in parkin-sonian patients with motor fluctuations. Ann Pharmacother 1998 Sep; 32(9): 878–83PubMedCrossRefGoogle Scholar
  123. 123.
    Smala AM, Spottke EA, Machat O, et al. Cabergoline versus levodopa monotherapy: a decision analysis. Mov Disord 2003; 18(8): 898–905PubMedCrossRefGoogle Scholar
  124. 124.
    Iskedjian M, Einarson TR. Cost analysis of ropinirole versus levodopa in the treatment of Parkinson’s disease. Pharmacoeconomics 2003; 21(2): 115–27PubMedCrossRefGoogle Scholar
  125. 125.
    Davey P, Rajan N, Lees M, et al. Cost-effectiveness of pergolide compared to bromocriptine in the treatment of Parkinson’s disease: a decision-analytic model. Value Health 2001; 4(4): 308–15PubMedGoogle Scholar
  126. 126.
    Findley LJ, Lees A, Apajasalo M, et al. Cost-effectiveness of levodopa/carbidopa/entacapone (Stalevo) compared to standard care in UK Parkinson’s disease patients with wearing-off. Curr Med Res Opin 2005 Jul; 21(7): 1005–14PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • Clare H. Dowding
    • 1
  • Claire L. Shenton
    • 1
  • Sam S. Salek
    • 1
    Email author
  1. 1.Centre for Socioeconomic Research, Welsh School of PharmacyCardiff UniversityCardiffUK

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