Costing the earth

We know that Parkinson’s exacts a heavy price. The individual has a raft of motor and non-motor symptoms that significantly reduce their quality of life. Their loved ones share that burden, and research has shown that their quality of life of suffers greatly, too.

To use they hackneyed phrase, “in these times of austerity”, it is vital to legitamise and acount for every penny spent. In order to pursuade people (more explicitly, funders) of the need to provide a service, talking about loss of quality of life is not enough. It all comes down to the ‘bottom line’.

We heartily welcome the comprehensive and up to date analysis of the cost of Parkinson’s in the UK. The authors (including Professor Anette Schrag, one of the leading investigators of the PREDICT-PD study) report the results of a review of UK national GP and health records from 1993 – 2013. They compared the health service use of everyone 30 years or older who were given a new diagnosis of Parkinson’s during this 20-year period, with people of the same age, gender and location (attend the same GP surgery).

Their results are both astounding and unsuprising. GP and hospital care costs £5000 per year on average for people with Parkinson’s, compared to only £2000 per year for the controls. Furthermore, as the condition became more advanced, so did the costs associated with it. These costs were due to GP visits, outpatient hospital visits, inpatient care, A&E attendances and medications.

What this study brings is an up to date assessment of the cost of Parkinson’s. When considering the number of people with the condition is likely to increase, this represents an invaluable method of identifying how crucial it is to provide better, more efficient services to the Parkinson’s community. It also underscores just how important it is to be able to provide a disease modifying treatment, that will reduce the rate of progression to the more advance, more expensive stages of the disease.

What this study was unable to account for is the non-NHS based costs. These have recently been estimated at around £16,500 per person per year: through lost earnings, time off work, and other out-of-pocket expenses (see figure – from Parkinson’s UK). Including all of these brings the average cost of PD for British society to about £25,000 per person per year!

Financial cost of living with Parkinson's including out of pocket expenses

RNR

https://onlinelibrary.wiley.com/doi/pdf/10.1002/mds.

Short- and long-term cost and utilization of health care resources in Parkinson's disease in the UK.

Mov Disord. 2018 Mar 30;12(12):956.

BACKGROUND:There is currently no robust long-term data on costs of treating patients with Parkinson's disease. The objective of this study was to report levels of health care utilization and associated costs in the 10 years after diagnosis among PD patients in the United Kingdom.

METHODS:We undertook a retrospective population-based cohort study using linked data from the UK Clinical Practice Research Datalink and Hospital Episode Statistics databases. Total health care costs of PD patients were compared with those of a control group of patients without PD selected using 1:1 propensity score matching based on age, sex, and comorbidity.

RESULTS:Between 1994 and 2013, 7271 PD patients who met study inclusion criteria were identified in linked Clinical Practice Research Datalink-Hospital Episode Statistics; 7060 were matched with controls. The mean annual health care cost difference (at 2013 costs) between PD patients and controls was £2471 (US$3716) per patient in the first year postdiagnosis (P < 0.001), increasing to £4004 (US$6021) per patient (P < 0.001) 10 years following diagnosis because of higher levels of use across all categories of health care utilization. Costs in patients with markers of advanced PD (ie, presence of levodopa-equivalent daily dose > 1100 mg, dyskinesias, falls, dementia, psychosis, hospital admission primarily due to PD, or nursing home placement) were on average higher by £1069 (US$1608) per patient than those with PD without these markers.

CONCLUSIONS:This study provides comprehensive estimates of health care costs in PD patients based on routinely collected data. Health care costs attributable to PD increase in the year following diagnosis and are higher for patients with indicators of advanced disease. © 2018 International Parkinson and Movement Disorder Society.