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Movement Disorders Parkinson’s Disease Social and Economic Benefits of Early Optimised Treatment for Parkinson’s Disease Patients – Improved Quality of Life and Greater Productivity Johan Lökk, 1 Ulf Persson 2 and Michael Wainwright 3 1. Professor and Head Physician, Geriatric Department, Institute of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm; 2. Professor of Health Economics, The Swedish Institute for Health Economics, Lund; 3. Uppsala Science Park, Uppsala, Sweden Abstract From a broad societal perspective, the economic burden of Parkinson’s disease ranges from direct medication expenses to costs associated with home help and lost production. The last two generally arise in the more advanced stages of the disease. Savings are nevertheless possible and the two main ways of attaining this are by slowing down disease progression and reducing the time patients spend in off-periods. Earlier onset of optimised treatment, both in the initial and later disease stages, has the potential to achieve both. We highlight examples of advanced therapies that alleviate severe motor symptoms and thereby prolong the time patients can remain in their own homes and at their places of work. Health economic calculations for two forms of advanced therapy, continuous dopaminergic stimulation via pumps and deep brain stimulation, are also shown. Keywords Parkinson’s disease, quality of life, advanced therapies, onset of treatment, socioeconomic burden, cost-utility Disclosure: Johan Lökk has received honoraria from Boehringer Ingelheim for lectures and has participated in clinical trials for Boehringer Ingelheim. Ulf Persson and Michael Wainwright have no conflicts of interest to declare. Acknowledgements: The authors thank Susanna Lindvall for her valuable advice and encouragement. Received: 17 February 2012 Accepted: 14 May 2012 Citation: European Neurological Review, 2012;7(2):113–7 Correspondence: Johan Lökk, Professor and Head Physician, Geriatric Department, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden. E: johan.lokk@karolinska.se Like other chronic neurodegenerative diseases, Parkinson’s disease (PD) is associated with an impaired quality of life (QoL) for patients and costs to society. In Sweden at 2011 prices, the overall average cost per patient and year has been estimated at SEK (Swedish crowns) 148,000 or €16,500. 1 In 2005 in Europe, the direct cost was estimated as €10.7 billion per year, but it was considered that the total costs may be around 40 % more. 2 Significantly, future costs in developed countries were predicted to double by 2030. Most of the costs associated with PD fall outside of the healthcare system, e.g. they are due to home care or lost productivity. A growing body of expertise believes that allocating more resources to early, optimised therapy can offset direct medication costs by raising patient QoL. This should reduce their need for home care and prolong the time they spend at work. We provide support for this view and show how economic simulation modelling can help generate meaningful cost-utility data. Socioeconomic Experiences of Focused Treatment in Haemophilia In developing countries with a per capita gross national product (GNP) of less than US$2,000, few citizens with haemophilia live beyond the age of nineteen. Many do not survive childhood. However, survival to adulthood and beyond increases approximately fivefold if these people have access to a specific haemophilia treatment centre (HTC). © TOUCH BRIEFINGS 2012 Data collected by the World Federation of Haemophilia (WFH) 3 clearly show that even minimal level treatment at a HTC boosted recovery from bleeding episodes and increased survival to adulthood. This resulted in a quicker return to school or work, as well as preserved functional independence. Absenteeism decreased, productivity improved and the burden on caregivers was reduced. A relatively modest investment in the health of haemophilia sufferers thus benefits both government and society since as adults they are able to work and contribute to the community. The long-term financial consequences of higher morbidity are avoided. This simple yet dramatic example has parallels with the treatment of PD in western countries. Although the costs of treating PD may be higher than the expenses of running a basic HTC, the economic resources of industrialised nations are correspondingly greater. So just as it makes economic sense for countries with even limited resources to provide organised haemophilia care, developed countries should evaluate the cost benefits of the therapeutic options available for PD. Expenses associated with providing optimised treatment as early as possible could be more than offset by improved outcome. Symptoms of Parkinson’s Disease PD is still primarily regarded as a movement disorder caused by the depleted production of the neurotransmitter substance dopamine (DA). 4 It is characterised by motor symptoms (MS) such 113