Therapie des Morbus Parkinson unter Kosten- und Qualitätsaspekten

Zusammenfassung

Zunehmend werden die direkten Kosten der Therapie des Morbus Parkinson diskutiert und reglementiert. Ziel dieser Übersicht ist eine Darstellung und Wertung der Ergebnisse gesundheitsökonomischer Studien zur Therapie des Morbus Parkinson. Kurzfristige Kosteneinsparung kann durch Verordnen günstiger Levodopapräparate zwar erreicht werden, langfristig führt dieses Behandlungskonzept aber eher zum Auftreten von Fluktuationen mit deren daraus resultierenden Folgekosten. Langzeitaspekte und Qualität einer notwendigen ganzheitlichen Therapie werden nur teilweise in den vorliegenden Studien berücksichtigt. Letztendlich sollten aber medizinische und nicht finanzielle Argumente entscheidend sein und dem Kranken der therapeutische Fortschritt aus kurzfristigen Kostengründen nicht vorenthalten werden, da sich neben einer verbesserten Lebensqualität so vor allem die sekundären indirekten Folgen dieser Erkrankung auch auf Kostenebene nachhaltig langfristig beeinflussen lassen.

Abstract

There is an increasing debate and control of direct costs of therapy of Parkinson's disease (PD). Aim of this review is to evaluate and discuss results of previously performed pharmacoeconomic trials on the cost effectiveness of therapy of PD patients. Levodopa preparations appear to be cheaper in the short-term, but in the long run this treatment without dopamine agonists causes earlier onset of motor complications with their resulting increase of direct and indirect costs and limited quality of life. However, these long-term aspects and quality of therapy, which also involves social viewpoints, are only partially considered. In the end, medical and not financial aspects are essential. The PD patient should benefit from progress in the treatment of PD. This will improve quality of life and at least decrease in particular secondary indirect costs of PD in the long-term.

Literatur

• 1 Singer E. Social costs of Parkinson's disease.  J Chronic Dis. 1973;  26 243-254
• 2 Clarke C E. Medical management of Parkinson's disease.  J Neurol Neurosurg Psychiatry. 2002;  72, Suppl 1 I22-I27
• 3 Dodel R C, Singer M, Kohne-Volland R. et al . The economic impact of Parkinson's disease. An estimation based on a 3-month prospective analysis.  Pharmacoeconomics. 1998;  14 299-312
• 4 Dodel R C, Eggert K M, Singer M S. et al . Costs of drug treatment in Parkinson's disease.  Mov Disord. 1998;  13 249-254
• 5 Hoerger T J, Bala M V, Rowland C. et al . Cost effectiveness of pramipexole in Parkinson's disease in the US.  Pharmacoeconomics. 1998;  14 541-557
• 6 Stamm T, Spycher S, Engfer A, Fahrenkrug E. Krankheitskosten des Morbus Parkinson in Deutschland.  Psycho. 1996;  22 212-228
• 7 Ogunniyi A. Treatment of parkinsonian syndromes in developing countries.  Afr J Med Sci. 1997;  26 101-103
• 8 Rubenstein L M, DeLeo A, Chrischilles E A. Economic and health-related quality of life considerations of new therapies in Parkinson's disease.  Pharmacoeconomics. 2001;  19 729-752
• 9 Rubenstein L M, Chrischilles E A, Voelker M D. The impact of Parkinson's disease on health status, health expenditures, and productivity. Estimates from the National Medical Expenditure Survey.  Pharmacoeconomics. 1997;  12 486-498
• 10 Tomaszewski K J, Holloway R G. Deep brain stimulation in the treatment of Parkinson's disease: a cost-effectiveness analysis.  Neurology. 2001;  57 663-671
• 11 Whetten-Goldstein K, Sloan F, Kulas E. et al . The burden of Parkinson's disease on society, family, and the individual.  J Am Geriatr Soc. 1997;  45 844-849
• 12 Dodel R C, Singer M, Kohne-Volland R. et al . Cost of illness in Parkinson disease. A retrospective 3-month analysis of direct costs.  Nervenarzt. 1997;  68 978-984
• 13 Keller S, Kessler T, Meuser T. et al . Analysis of direct costs in therapy of Parkinson disease.  Nervenarzt. 2003;  74 1105-1109
• 14 Müller T, Voss B, Hellwig K. et al . Treatment benefit and daily drug costs associated with treating Parkinson's disease in a Parkinson's disease clinic.  CNS Drugs. 2004;  18 105-111
• 15 Müller T, Voss B, Hellwig K, Przuntek H. Treatment benefit correlates with increase of daily drug costs in Parkinson's disease clinics.  NeuroRehabilitation. 2003;  18 271-275
• 16 LePen C, Wait S, Moutard-Martin F. et al . Cost of illness and disease severity in a cohort of French patients with Parkinson's disease.  Pharmacoeconomics. 1999;  16 59-69
• 17 Muhlack S, Woitalla D, Welnic J. et al . Chronic levodopa intake increases levodopa plasma bioavailability in patients with Parkinson's disease.  Neurosci Lett. 2004;  363 284-287
• 18 Müller T, Kuhn W, Przuntek H. Therapie mit Amantadinsalzen. In: Oertel WH (Hrsg) Pharmakotherapie der Parkinson-Krankheit. 11. Frankfurter Symposion 12. - 14.3.1998. Stuttgart; Schattauer Basel, Grenzach-Wyhlen; Editiones Roche 2004: 123-130
• 19 Fritze J. Psychopharmacological regulations. Results and commentary to the report on drug regulations 2002.  Nervenarzt. 2003;  74 301-306
• 20 Fritze J, Schmauss M. Alteration of the guidelines on pharmaceuticals of the National Committee of Physicians and Health Insurers with regard to atypical neuroleptics. Statement of the German Scoiety of Psychiatry, Psychotherapy and Neurology (DGPPN).  Nervenarzt. 2003;  74 97-99
• 21 Fritze J, Schmauss M. Off-label use in psychopharmacotherapy.  Nervenarzt. 2002;  73 796-799
• 22 Factor S A, Friedman J H. The emerging role of clozapine in the treatment of movement disorders.  Mov Disord. 1997;  12 483-496
• 23 Fischer P A, Baas H, Hefner R. Treatment of parkinsonian tremor with clozapine.  J Neural Transm Park Dis Dement Sect. 1990;  2 233-238
• 24 Friedman J H, Lannon M C. Clozapine-responsive tremor in Parkinson's disease.  Mov Disord. 1990;  5 225-229
• 25 Pakkenberg H, Pakkenberg B. Clozapine in the treatment of tremor.  Acta Neurol Scand. 1986;  73 295-297
• 26 Happe S, Pirker W, Sauter C. et al . Successful treatment of excessive daytime sleepiness in Parkinson's disease with modafinil.  J Neurol. 2001;  248 632-634
• 27 Hogl B, Saletu M, Brandauer E. et al . Modafinil for the treatment of daytime sleepiness in Parkinson's disease: a double-blind, randomized, crossover, placebo-controlled polygraphic trial.  Sleep. 2002;  25 905-909
• 28 Aarsland D, Tandberg E, Larsen J P, Cummings J L. Frequency of dementia in Parkinson disease.  Arch Neurol. 1996;  53 538-542
• 29 Emre M, Aarsland D, Albanese A. et al . Rivastigmine for dementia associated with Parkinson's disease.  N Engl J Med. 2004;  351 2509-2518
• 30 Berry R A, Murphy J F. Well-being of caregivers of spouses with Parkinson's disease.  Clin Nurs Res. 1995;  4 373-386
• 31 Montgomery jr E B, Lieberman A, Singh G, Fries J F. Patient education and health promotion can be effective in Parkinson's disease: a randomized controlled trial. PROPATH Advisory Board.  Am J Med. 1994;  97 429-435
• 32 Noyes K, Dick A W, Holloway R G. Pramipexole v. levodopa as initial treatment for Parkinson's disease: a randomized clinical-economic trial.  Med Decis Making. 2004;  24 472-485
• 33 Hempel A G, Wagner M L, Maaty M A, Sage J I. Pharmacoeconomic analysis of using Sinemet CR over standard Sinemet in parkinsonian patients with motor fluctuations.  Ann Pharmacother. 1998;  32 878-883
• 34 Przuntek H, Welzel D, Gerlach M. et al . Early institution of bromocriptine in Parkinson's disease inhibits the emergence of levodopa-associated motor side effects. Long-term results of the PRADO study.  J Neural Transm Gen Sect. 1996;  103 699-715
• 35 Rascol O, Brooks D J, Korczyn A D. et al . A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. 056 Study Group.  N Engl J Med. 2000;  342 1484-1491
• 36 Whone A L, Watts R L, Stoessl A J. et al . Slower progression of Parkinson's disease with ropinirole versus levodopa: The REAL-PET study.  Ann Neurol. 2003;  54 93-101
• 37 Müller T, Renger K, Kuhn W. Levodopa-associated increase of homocysteine levels and sural axonal neurodegeneration.  Arch Neurol. 2004;  61 657-660
• 38 Fahn S, Oakes D, Shoulson I. et al . Levodopa and the progression of Parkinson's disease.  N Engl J Med. 2004;  351 2498-2508
• 39 Facca A, Sanchez-Ramos J. High-dose pergolide monotherapy in the treatment of severe levodopa-induced dyskinesias.  Mov Disord. 1996;  11 327-329
• 40 Müngersdorf M, Sommer U, Sommer M, Reichmann H. High-dose therapy with ropinirole in patients with Parkinson's disease.  J Neural Transm. 2001;  108 1309-1317
• 41 Müller T, Fritze J. Fibrosis associated with dopamine agonist therapy in Parkinson's disease.  Clin Neuropharmacol. 2003;  26 109-111
• 42 Meissner W, Trottenberg T, Klaffke S. et al . Apomorphine therapy versus deep rain stimulation. Clinical and economic aspects in patients with advanced Parkinson disease.  Nervenarzt. 2001;  72 924-927
• 43 Spottke E A, Volkmann J, Lorenz D. et al . Evaluation of healthcare utilization and health status of patients with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus.  J Neurol. 2002;  249 759-766
• 44 Drucker-Colin R, Verdugo-Diaz L. Cell transplantation for Parkinson's disease: present status.  Cell Mol Neurobiol. 2004;  24 301-316
• 45 Harrower T P, Barker R A. Is there a future for neural transplantation?.  BioDrugs. 2004;  18 141-153
• 46 Olanow C W, Goetz C G, Kordower J H. et al . A double-blind controlled trial of bilateral fetal nigral transplantation in Parkinson's disease.  Ann Neurol. 2003;  54 403-414
• 47 Berney A, Vingerhoets F, Perrin A. et al . Effect on mood of subthalamic DBS for Parkinson's disease: a consecutive series of 24 patients.  Neurology. 2002;  59 1427-1429
• 48 Lyons K E, Pahwa R. Deep brain stimulation in Parkinson's disease.  Curr Neurol Neurosci Rep. 2004;  4 290-295
• 49 Charles P D, Padaliya B B, Newman W J. et al . Deep brain stimulation of the subthalamic nucleus reduces antiparkinsonian medication costs.  Parkinsonism Relat Disord. 2004;  10 475-479
• 50 D'Ausilio A, Marconi S, Antonini A. et al . Cost analysis in Italy of various strategies for the treatment of Parkinson disease in the advanced phase.  Recenti Prog Med. 2003;  94 484-493
• 51 Meissner W, Schreiter D, Volkmann J. et al . Deep brain stimulation in late stage Parkinson's disease: a retrospective cost analysis in Germany.  J Neurol. 2005;  252 218-223
• 52 Bryson H M, Milne R J, Chrisp P. Selegiline: an appraisal of the basis of its pharmacoeconomic and quality-of-life benefits in Parkinson's disease.  Pharmacoeconomics. 1992;  2 118-136
• 53 Diener H C. Leitlinien für Diagnostik und Therapie in der Neurologie. Stuttgart, New York; Georg Thieme Verlag 2003
• 54 Przuntek H, Müller T, Riederer P. Diagnostic staging of Parkinson's disease: conceptual aspects.  J Neural Transm. 2004;  111 201-216