Social and economic cost of L-Dopa-induced dyskinesias in patients with Parkinson's disease.

Long term L-Dopa medication mainly induces two complications in Parkinson's Disease (PD) patients, ie. motor fluctuations and dyskinesias. Both of the se complications can significantly impair the patient's quality of life. At a high degree of severity, dyskinesias can interfere with everyday tasks, balance, speech, etc. From a clinical point of view, they lead to complicat ed L-Dopa dose adjustments or to the use of sustained release forms. For th ese reasons, L-Dopa-induced dyskinesias may have a significant human and fi nancial impact We have designed a retrospective study to explore two aspect s of PD, i.e. the impact of dyskinesias on patient's social life and their economic cost Ten French neurologists were randomly selected from a nationa l file to participate in this study. They were asked to include 4 patients with PD currently under L-Dopa medication and showing 4 different levels of dyskinesia severity, i.e. absent, moderate, mild and severe dyskinesia, ac cording to the Unified Parkinson Disease Rating Scale, with no other specif ic inclusion criteria. Two specific scales were to be completed, Hoehn & Ya hr on disease severity and Schwab & England on degree of independence. Clin ical profiles of patients, demographics and use of medical resources were a lso recorded, investigators were interviewed about their practice. This stu dy showed that patients with dyskinesias had an earlier onset of the diseas e (11.2 years vs. 3.7 years). They also had a higher level of disease sever ity, according to the Hoehn & Yahr scale (40p. cent vs. Op. cent presenting a level of 4). The mean monthly cost was significantly higher for patients with dyskinesias (FF 3 733 versus FF 1 109, p = 0.0005). Particularly, the presence of dyskinesias had a significant impact on treatment costs and me dical visits. A positive gradient of the medical cost with level of dyskine sia severity was also underlined. In the same way, the more severe the dysk inesia status the greater the need for caregivers. Finally, based on these results, the total annual medical cost of dyskinesias in France was estimat ed between 588 and 812 million francs.