Economic and health-related quality of life considerations of new therapies in Parkinson's disease

The progressive disability of Parkinson's disease results in substantial bu rdens for patients, their families and society in terms of increased health resource use, poorer quality of life, caregiver burden, disrupted family r elationships, decreases in social and leisure activities, deteriorating emo tional well-being, and direct and indirect costs of illness. Health-related quality of life (HR-QOL) measures have been used successfull y in cross-sectional studies to identify and characterise these burdens; ho wever, there is not yet substantial evidence that these instruments will be responsive to changes in patients over time and that the results will prov ide patients and health professionals with clinically meaningful informatio n useful in making decisions about treatment strategies. The few studies documenting direct and indirect costs indicate increased us e of ancillary health and community services, significant adaptations in ho me and transportation, increased use of mobility and self-care aids, and la ck of access to appropriate healthcare providers. Patients with Parkinson's disease incur higher hospital expenses, have increased number of prescript ions, and experience earnings loss; the latter also applies to family careg ivers. The choice, intensity and timing of therapy are determined by a variety of factors: presenting symptoms, age, employment status, comorbidity, cognitiv e impairment and level of functional impairment. Choices must be individual ly tailored to a patient's physical and personal needs. To be useful for patients with Parkinson's disease in clinical practice, cl inicians should be able to use HR-QOL measures to identify appropriate medi cal interventions or socio-behavioural modifications to modify the HR-QOL d eficits. However, while the interplay of interventions and clinical outcome s are often well understood, the effects of interventions on HR-QOL outcome s have not been studied extensively. Little research has been done that exp licitly links the signs and symptoms of Parkinson's disease to the HR-QOL o utcomes. The only Parkinson's disease cost-effectiveness study as yet performed indi cated higher mat, fnr patient, receiving pramipexole than fnr those not tak ing the drug, but additional quality life-years were gained. Longer term effectiveness of many treatment strategies, and the usefulness of HR-QOL instruments to assess these treatments for individual patients ov er time, are critical areas for future research.