Impact of Parkinson's disease and its pharmacologic treatment on quality of life and economic outcomes

The impact of Parkinson's disease (PD) and its pharmacologic treatment on h ealth-related quality of life (HRQL) and economic outcomes is reviewed. PD is a chronic and progressive neurologic disorder characterized by specif ic motor deficits resulting from the degeneration of dopaminergic neurons i n the substantia nigra. The cardinal symptoms are tremor, rigidity, bradyki nesia, and loss of postural reflexes. PD markedly reduces HRQL and places a n economic burden on society of up to $25 billion per year. Patients' inabi lity to move freely and to perform everyday tasks restricts their independe nce and leads to increased reliance on caregivers and assistive devices. Em otional and psychosocial well-being is also negatively affected. As the dis ease progresses, the response to levodopa typically decreases and various m otor complications develop; these are difficult to treat and result in furt her declines in HRQL. The economic costs of PD include both direct health c are costs (for drugs, physician services, and hospitalization) and indirect costs (for lost workers productivity). Economic analyses of PD and its tre atments can help guide effective allocation of health care resources. Vario us antiparkinson agents and formulations, such as extended-release levodopa -carbidopa and pramipexole, have been found to be cost-effective relative t o other agents. The newest antiparkinsonian drugs, cathechol-O-methyltransf erase inhibitors, also have the potential to improve HRQL and economic outc omes, although more study is needed to confirm this. The total impact of PD and its treatment can be fully appreciated only when HRQL and economic outcomes, in addition to clinical outcomes, are examined .