The Economic Impact of Parkinson`s Disease: An Estimation Based on a 3-Month Prospective Analysis

Objective: This study prospectively assesses the medical costs of Parkinson's disease (PD). Design: Over a period of 3 months (from July to September 1995), patients with PD documented all items of healthcare provision. These data were then used to calculate medical costs for an individual patient as well as the costs of PD. Patients and setting: We included 20 outpatients with idiopathic PD from the neurological outpatient clinic, Klinikum Grosshadern, Munich, and 20 patients from two office-based neurologists in South-West Germany. Main results: The mean 3-month medical cost of PD in 1995 deutschmarks (DM) was 5210 ($US3390, Lstg 2240) consisting of DM1410 ($US920, Lstg 610) for care and nursing, DM1580 ($US1030, Lstg 680) for drug therapy, DM1320 ($US860, Lstg 570) for inpatient hospital care, DM40 ($US26, Lstg 17) for outpatient care and DM860 for other expenses ($US560, Lstg 370). The expenditure was related to the disease evolution. Patients complaining of one-sided symptoms [Hoehn and Yahr stage I; (HY I)] were less expensive to treat (DM1930, $US1250, Lstg 830) than patients who were severely incapacitated (HY V) [DM9740, $US6330, Lstg 4200; HY V]. After 3 to 5 years of levodopa treatment approximately 50% of patients start to experience fluctuations in motor ability and dyskinesias [Unified Parkinson's disease rating scale, part IV (UPDRS IV)]. This onset of motor complications parallels an increase in costs. For patients who experienced motor fluctuations, annual costs were DM6550 ($US4260, Lstg 2820) compared with DM3030 ($US1960, Lstg 1300) for patients lacking this problem. Indirect non-medical costs were not calculated due to the limited number of patients. The impact of the disease on work, however, is clearly apparent from the patients' history: 19 out of 34 patients who had already stopped working attributed this to the disease, and only 6 patients were still working at the time of the survey. Conclusion: PD poses a major financial impact to society which is expected to increase in future years as the age distribution shifts to older age groups. On the basis of a prevalence of PD of 183 per 100 000, we calculated an annual expenditure of DM3.0 billion for the direct medical costs of PD in Germany.