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Chen HC, Wang CY, Chen HH, Liou HH. Cost-effectiveness of the add-on exenatide to conventional treatment in patients with Parkinson’s disease when considering the coexisting effects of diabetes mellitus. PLoS One 2022; 17:e0269006. [PMID: 35951654 PMCID: PMC9371359 DOI: 10.1371/journal.pone.0269006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Objective This study aims to investigate the cost-effectiveness of the add-on exenatide to conventional pharmacotherapy in patients with Parkinson’s disease (PD) when considering the coexistence of diabetes mellitus (DM). Methods We used the Keelung and Community-based Integrated Screening databases to understand the medical utilisation in the Hoehn and Yahr stages of patients with PD. A Markov model with 1-year cycle length and 50-year time horizon was used to assess the cost-effectiveness of add-on exenatide to conventional pharmacotherapy compared to conventional pharmacotherapy alone. All costs were adjusted to the value of the new Taiwanese dollar (NT$) as of the year 2020. One-way sensitivity and probability analyses were performed to test the robustness of the results. Results From a societal perspective, the add-on exenatide brought an average of 0.39 quality-adjusted life years (QALYs) gained, and a cost increment of NT$104,744 per person in a 50-year horizon compared to conventional pharmacotherapy. The incremental cost-effectiveness ratio (ICER) was NT$268,333 per QALY gained. As the ICER was less than the gross domestic product per capita (NT$839,558), the add-on exenatide was considered to be very cost-effective in the two models, according to the World Health Organization recommendation. Add-on exenatide had a 96.9% probability of being cost-effective in patients with PD, and a 100% probability of being cost-effective in patients with PD and DM. Conclusion Add-on exenatide is cost-effective in PD combined with DM. Considering that DM may be a risk factor for neurodegenerative diseases, exenatide provides both clinical benefits and cost-effectiveness when considering both PD and DM.
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Affiliation(s)
- Hsuan-Chih Chen
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Yu Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Prevention Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Horng- Huei Liou
- Department of Neurology, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
- Department of Neurology and Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Kay KR, Uc EY. Real-life consequences of cognitive dysfunction in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:113-136. [DOI: 10.1016/bs.pbr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Direct Cost of Parkinson's Disease: A Real-World Data Study of Second-Line Therapies. PARKINSONS DISEASE 2020; 2020:9106026. [PMID: 32454967 PMCID: PMC7240660 DOI: 10.1155/2020/9106026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 11/18/2022]
Abstract
Parkinson's disease is one of the main reasons for neurological consultation in Spain. Due to the nature of the disease, it impacts patients, families, and caregivers. Parkinson's disease is a degenerative disease with no cure, although second-line therapies have recently improved the quality of life of patients in advanced stages. The aim of this study was to analyse the costs of the following therapies: deep brain stimulation (DBS), continuous duodenal levodopa/carbidopa infusion (CDLCI), and continuous subcutaneous apomorphine infusion (CSAI). The methodology used was based on real-world data obtained from an integrated healthcare organization in the Basque Country from 2016 to 2018. This bottom-up retrospective approach only took into account the healthcare perspective. The results revealed the annual cost over 3 years and the projected cost for an additional 2 years. The total costs for 5 years of treatment were as follows: €53,217 for DBS, €208,163 for CDLCI, and €170,591 for CSAI. These costs are in line with those found in the available literature on the subject. Additionally, the analysis provided details of the different costs incurred during intervention with the therapies and compared the costs to those reported in other studies.
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Foo ASC, Soong TW, Yeo TT, Lim KL. Mitochondrial Dysfunction and Parkinson's Disease-Near-Infrared Photobiomodulation as a Potential Therapeutic Strategy. Front Aging Neurosci 2020; 12:89. [PMID: 32308618 PMCID: PMC7145956 DOI: 10.3389/fnagi.2020.00089] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/17/2020] [Indexed: 12/21/2022] Open
Abstract
As the main driver of energy production in eukaryotes, mitochondria are invariably implicated in disorders of cellular bioenergetics. Given that dopaminergic neurons affected in Parkinson's disease (PD) are particularly susceptible to energy fluctuations by their high basal energy demand, it is not surprising to note that mitochondrial dysfunction has emerged as a compelling candidate underlying PD. A recent approach towards forestalling dopaminergic neurodegeneration in PD involves near-infrared (NIR) photobiomodulation (PBM), which is thought to enhance mitochondrial function of stimulated cells through augmenting the activity of cytochrome C oxidase. Notwithstanding this, our understanding of the neuroprotective mechanism of PBM remains far from complete. For example, studies focusing on the effects of PBM on gene transcription are limited, and the mechanism through which PBM exerts its effects on distant sites (i.e., its "abscopal effect") remains unclear. Also, the clinical application of NIR in PD proves to be challenging. Efficacious delivery of NIR light to the substantia nigra pars compacta (SNpc), the primary site of disease pathology in PD, is fraught with technical challenges. Concerted efforts focused on understanding the biological effects of PBM and improving the efficiency of intracranial NIR delivery are therefore essential for its successful clinical translation. Nonetheless, PBM represents a potential novel therapy for PD. In this review, we provide an update on the role of mitochondrial dysfunction in PD and how PBM may help mitigate the neurodegenerative process. We also discussed clinical translation aspects of this treatment modality using intracranially implanted NIR delivery devices.
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Affiliation(s)
- Aaron Song Chuan Foo
- Department of Physiology, National University of Singapore, Singapore, Singapore
- Division of Neurosurgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Tuck Wah Soong
- Department of Physiology, National University of Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Kah-Leong Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Research, National Neuroscience Institute, Singapore, Singapore
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Mikos V, Heng CH, Tay A, Yen SC, Chia NSY, Koh KML, Tan DML, Au WL. A Wearable, Patient-Adaptive Freezing of Gait Detection System for Biofeedback Cueing in Parkinson's Disease. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2019; 13:503-515. [PMID: 31056518 DOI: 10.1109/tbcas.2019.2914253] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Freezing of Gait (FoG) is a common motor-related impairment among Parkinson's disease patients, which substantially reduces their quality of life and puts them at risk of falls. These patients benefit from wearable FoG detection systems that provide timely biofeedback cues and hence help them regain control over their gait. Unfortunately, the systems proposed thus far are bulky and obtrusive when worn. The objective of this paper is to demonstrate the first integration of an FoG detection system into a single sensor node. To achieve such an integration, features with low computational load are selected and dedicated hardware is designed that limits area and memory utilization. Classification is achieved with a neural network that is capable of learning in real time and thus allows the system to adapt to a patient during run-time. A small form factor FPGA implements the feature extraction and classification, whereas a custom PCB integrates the system into a single node. The system fits into a 4.5 × 3.5 × 1.5 cm 3 housing case, weighs 32 g, and achieves 95.6% sensitivity and 90.2% specificity when adapted to a patient. Biofeedback cues are provided either through auditory or somatosensory means and the system can remain operational for longer than 9 h while providing cues. The proposed system is highly competitive in terms of classification performance and excels with respect to wearability and real-time patient adaptivity.
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Chaudhuri KR, Titova N. Societal Burden and Persisting Unmet Needs of Parkinson’s Disease. ACTA ACUST UNITED AC 2019. [DOI: 10.17925/enr.2019.14.1.28] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bovolenta TM, de Azevedo Silva SMC, Saba RA, Borges V, Ferraz HB, Felicio AC. Average annual cost of Parkinson's disease in São Paulo, Brazil, with a focus on disease-related motor symptoms. Clin Interv Aging 2017; 12:2095-2108. [PMID: 29276379 PMCID: PMC5734235 DOI: 10.2147/cia.s151919] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Although Parkinson's disease is the second most prevalent neurodegenerative disease worldwide, its cost in Brazil - South America's largest country - is unknown. Objective The goal of this study was to calculate the average annual cost of Parkinson's disease in the city of São Paulo (Brazil), with a focus on disease-related motor symptoms. Subjects and methods This was a retrospective, cross-sectional analysis using a bottom-up approach (ie, from the society's perspective). Patients (N=260) at two tertiary public health centers, who were residents of the São Paulo metropolitan area, completed standardized questionnaires regarding their disease-related expenses. We used simple and multiple generalized linear models to assess the correlations between total cost and patient-related, as well as disease-related variables. Results The total average annual cost of Parkinson's disease was estimated at US$5,853.50 per person, including US$3,172.00 in direct costs (medical and nonmedical) and US$2,681.50 in indirect costs. Costs were directly correlated with disease severity (including the degree of motor symptoms), patients' age, and time since disease onset. Conclusion In this study, we determined the cost of Parkinson's disease in Brazil and observed that disease-related motor symptoms are a significant component of the costs incurred on the public health system, patients, and society in general.
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Affiliation(s)
| | | | - Roberta Arb Saba
- Neurology Department, Federal University of São Paulo, UNIFESP, São Paulo, Brazil
| | - Vanderci Borges
- Neurology Department, Federal University of São Paulo, UNIFESP, São Paulo
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Economic Burden Analysis of Parkinson's Disease Patients in China. PARKINSONS DISEASE 2017; 2017:8762939. [PMID: 28695039 PMCID: PMC5488490 DOI: 10.1155/2017/8762939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/10/2017] [Indexed: 11/21/2022]
Abstract
Background and Objective Parkinson's Disease (PD) is a progressive neurodegenerative disorder, which is prevalent in people over 65 years old. PD reduces patients' quality of life and exerts a heavy economic burden on patients and their families. The purpose of this research is to identify the costs of PD and to evaluate the economic distribution of medical care for PD patients in China. Methods A professional survey was administered to 116 patients with PD. Records of medical cost were reviewed. Direct and indirect costs were analyzed. The main cost-driving factors of PD were identified using multivariate regression analysis. Results The average annual cost per PD patient in China is $3,225.94, with direct and indirect costs accounting for $2,503.46 and $722.48, respectively. Direct costs consist of $556.27 for surgery, $44.67 for appointment fees, $605.67 for prescription medication, $460.29 for hospitalization, $71.03 for auxiliary examination, $35.64 for transportation, $10.39 for special equipment, and $719.50 for formal care. The total cost is closely related to surgical treatment, dopamine agonist, and levodopa costs. Conclusion The cost of PD patients in China is considerable and exceeds average economic capacity, especially antiparkinson medication and caring costs. This study may provide a reference for PD healthcare optimization in the future.
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Systematic Review and Critical Analysis of Cost Studies Associated with Parkinson's Disease. PARKINSONS DISEASE 2017; 2017:3410946. [PMID: 28357150 PMCID: PMC5357537 DOI: 10.1155/2017/3410946] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/24/2017] [Accepted: 02/12/2017] [Indexed: 11/17/2022]
Abstract
Parkinson's disease (PD) is the second most prevalent neurodegenerative disease worldwide, affecting more than four million people. Typically, it affects individuals above 45, when they are still productive, compromising both aging and quality of life. Therefore, the cost of the disease must be identified, so that the use of resources can be rational and efficient. Additionally, in Brazil, there is a lack of research on the costs of neurodegenerative diseases, such as PD, a gap addressed in this study. This systematic review critically addresses the various methodologies used in original research around the world in the last decade on the subject, showing that costs are hardly comparable. Nonetheless, the economic and social impacts are implicit, and important information for public health agents is provided.
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Rodríguez-Blázquez C, Forjaz MJ, Lizán L, Paz S, Martínez-Martín P. Estimating the direct and indirect costs associated with Parkinson’s disease. Expert Rev Pharmacoecon Outcomes Res 2015; 15:889-911. [DOI: 10.1586/14737167.2015.1103184] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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