The economic impact of Parkinson's disease
Introduction
Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder that causes significant disability and reduces quality of life. It is the second most common neurodegenerative disorder after Alzheimer's disease [1] and is a major and increasing burden on patients, families, carers and on healthcare systems [2]. One in seven patients with PD is under the age of 50 years, and there is an increase in prevalence with increasing age. The prevalence of PD in industrialised countries is thought to be approximately 0.3% [3]. This rises to 1% in people over the age of 60 and 3% in people over 80 years [1]. In the UK, PD is estimated to affect 100–180 per 100,000 of the population and has an annual incidence of 4–20 per 100,000 [4]. As the population ages, PD is likely to become more prevalent.
The burden of illness associated with PD is related not only to the disease itself, but also to the progressive disability that patients experience as their disease advances. Impairments in motor function cause problems with mobility and interfere with activities of daily living. Problems with balance and gait can lead to falls and injuries, and the inability to perform everyday tasks. Non-motor complications also increase over time and dementia, depression and other neuropsychiatric disorders are commonly reported comorbidities [5], [6], [7]. A recent study of PD patients who had been diagnosed for up to 18 years reported high proportions of patients reporting cognitive decline (84%), falls (81%), hallucinations (50%), depression (50%), dysphagia (50%), urinary incontinence (41%) and symptomatic postural hypotension (35%) [8]. These complications restrict the patient's independence, limit social and recreational activities and lead to increased reliance on carers and the healthcare system [9].
PD also has a marked impact on quality of life at all stages of the disease and at all ages. Studies indicate that quality of life is affected not only by the symptoms of PD, including bradykinesia, tremor and rigidity, but also by depression and cognitive state [2], [10], [11]. Although drug treatment improves quality of life [12], there is a significant deterioration in the domains of physical mobility, pain, social isolation and emotional reactions as the disease progresses [13]. The largest study of quality of life in PD to date is the Global Parkinson's Disease Survey [14], which reported that the major influence on quality of life is emotional status, especially depression and secondarily, the disease stage. This decline in quality of life affects not only patients and carers, but also has been associated with increased economic cost of illness [15].
Despite the progressive decline and comorbidity associated with PD, the lifespan of affected individuals, with modern drug therapy, does not differ greatly from age-matched individuals without PD [16]. As a result, people may live up for 20 or more years with PD. This finding has serious implications for the cost of treating PD over the individual's lifetime and suggests that the financial burden will escalate over time. In addition, the economic burden is likely to increase further as the proportion of individuals in Western societies aged over 65 increases [17]. This paper reviews analyses of the cost of PD and provides an estimate of the total economic burden of PD in the UK.
Section snippets
Assessing the economic cost of PD
Cost-of-illness studies measure the economic burden of a disease. These studies may include direct costs (healthcare resource use and drugs) and indirect costs (mortality costs, lost productivity and carer replacement costs). Direct costs can be used to help policy makers and other stakeholders make funding decisions, while indirect costs highlight the value of resources lost to society or the individual due to a particular illness. Estimates of the total burden of disease on society should
Cost of PD in the US
The most recent estimate of the cost of PD in the United States used a retrospective analysis of health insurance claims data to compare the cost between a cohort of patients with PD and cohort without PD who were matched for age, sex, insurance type and period of eligibility for benefits [6]. The cost calculations included inpatient care, emergency room visits, outpatient services and prescription drugs. The authors reported the economic burden as the difference in cost between the PD cohort
Cost of PD in the UK
Few studies have examined the cost of PD in the UK. An early study conducted by the Office of Health Economics in 1988/1989 reported an annual cost to the National Health Service of £126 million [21]. This figure was based on national statistics and considered direct costs only. More recently, we used a cross-sectional, survey-based approach to evaluate the total economic impact of PD on both healthcare providers and patients in the UK [22]. The survey population was drawn from a group of
Direct costs in the UK
A total of 432 patients were included in the survey and the total direct cost of care was £5993 per patient per year. At 38%, NHS costs represented the highest proportion of the direct costs, followed by social services costs (35%) and private expenditure (27%). However, the NHS costs accounted for a much higher proportion of costs in the younger age groups (Fig. 1). In patients <65 years of age, NHS costs were 65% of the total compared with 21% in patients >65 years. Conversely, both social
Indirect costs in the UK
The method used to evaluate indirect costs has a major impact on the total cost. Using data from our study, for example, indirect costs varied 16-fold depending on the method chosen for evaluation. If lost productivity for the patient was considered, the indirect costs are relatively low at £1668 per patient per year. This is because most PD patients are either close to or beyond the typical retirement age. Using the lost leisure time approach, costs increased appreciably to £5829. However, if
Total cost of PD in the UK
Using the figures described above and current PD prevalence rates, it is possible to extrapolate the overall cost of PD in the UK. The most conservative scenario assumes that there are 58,600 PD patients in the UK and uses the lost productivity approach to estimate indirect costs. The total cost using this approach is £449 million annually. As illustrated in Fig. 3, the cost increases if a higher prevalence of 100,000 patients in the UK is used, or if a different model is used to estimate the
Conclusions
The cost of PD is extremely high in both economic terms and in terms of the impact on patients’ lives. As PD progresses, patients are more likely to develop comorbid conditions and their quality of life and family relationships suffer. Economic costs escalate as the disease becomes more severe and patients use more healthcare resources. Ultimately, many patients require expensive institutional care. The economic cost of PD is not restricted to the healthcare system. Private expenditure on PD
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