Cost of illness and disease severity in a cohort of French patients with Parkinson's disease

Objective: To assess the relationship between severity and progression of i llness in Parkinson's disease and the use of healthcare resources. Design and setting: This was a prospective cost-of-illness study conducted in France based on clinical observation over a 6-month period of patients w ith Parkinson's disease treated in the hospital or community setting. Regre ssion analyses were performed to construct the model that offered the best explanation for health expenditures using clinical and sociodemographic ind icators. Patients and participants: All patients included in the study had well-defi ned idiopathic Parkinson's disease, were aged >35 years, were receiving tre atment with levodopa or other antiparkinsonian agents, and were capable of completing questionnaires, alone or with the help of a household member. Th e final study population consisted of 294 patients, of whom 54 were enrolle d by general practitioners and 240 by neurologists. Interventions: Investigators completed a clinical questionnaire at the begi nning and end of the 6-month observation period. Patients completed a quest ionnaire on their daily living conditions at the beginning and end of the s tudy, and also completed monthly reports of healthcare use and loss of prod uctivity. Patients with motor fluctuations also filled in fluctuation diari es on 4 consecutive days at the beginning and end of the B-month period. Re source data collected included hospital stays, ancillary care, drug therapy , medical visits and transportation. Social costs were evaluated in nonmone tary terms, with the exception of costs of adapting the home environment. T ransfer payments were analysed using reports from patients. Main outcome measures and results: Hospital stays were the most expensive c omponent of care (39% of costs), followed by ancillary care (30%) and drug therapy (22%). The mean medical cost was 308 euros (EUR) [$US357] for patie nts followed by a general practitioner and EUR2580 ($US2993) for patients f ollowed by a neurologist. Costs also varied with age and motor fluctuations . Medical costs were strongly correlated with most clinical indicators and th e cost generally progressed in line with the severity of the disease. The s trongest correlation was between clinical indicators and ancillary care cos ts. Conclusions: These results confirm the importance of the social burden of P arkinson's disease. The regression results could be used to evaluate the be nefit of novel treatments that reduce the intensity of motor fluctuations.