Scheife R T, Schumock G T, Burstein A, Gottwald M D, Luer M S
Tufts University School of Medicine, Boston, MA, USA.
Am J Health Syst Pharm. 2000 May 15;57(10):953-62. doi: 10.1093/ajhp/57.10.953.
The impact of Parkinson's disease (PD) and its pharmacologic treatment on health-related quality of life (HRQL) and economic outcomes is reviewed. PD is a chronic and progressive neurologic disorder characterized by specific motor deficits resulting from the degeneration of dopaminergic neurons in the substantia nigra. The cardinal symptoms are tremor, rigidity, bradykinesia, and loss of postural reflexes. PD markedly reduces HRQL and places an economic burden on society of up to $25 billion per year. Patients' inability to move freely and to perform everyday tasks restricts their independence and leads to increased reliance on caregivers and assistive devices. Emotional and psychosocial well-being is also negatively affected. As the disease progresses, the response to levodopa typically decreases and various motor complications develop; these are difficult to treat and result in further declines in HRQL. The economic costs of PD include both direct health care costs (for drugs, physician services, and hospitalization) and indirect costs (for lost worker productivity). Economic analyses of PD and its treatments can help guide effective allocation of health care resources. Various antiparkinsonian agents and formulations, such as extended-release levodopa-carbidopa and pramipexole, have been found to be cost-effective relative to other agents. The newest antiparkinsonian drugs, cathechol-O-methyltransferase inhibitors, also have the potential to improve HRQL and economic outcomes, although more study is needed to confirm this. The total impact of PD and its treatment can be fully appreciated only when HRQL and economic outcomes, in addition to clinical outcomes, are examined.
本文综述了帕金森病（PD）及其药物治疗对健康相关生活质量（HRQL）和经济结局的影响。PD是一种慢性进行性神经疾病，其特征是黑质中多巴胺能神经元变性导致特定的运动缺陷。主要症状为震颤、僵硬、运动迟缓及姿势反射丧失。PD显著降低了HRQL，并给社会带来每年高达250亿美元的经济负担。患者无法自由活动和完成日常任务限制了他们的独立性，并导致对护理人员和辅助设备的依赖增加。情绪和心理社会幸福感也受到负面影响。随着疾病进展，对左旋多巴的反应通常会降低，各种运动并发症会出现；这些并发症难以治疗，并导致HRQL进一步下降。PD的经济成本包括直接医疗成本（用于药物、医生服务和住院）和间接成本（因工人生产力损失）。对PD及其治疗的经济分析有助于指导医疗资源的有效分配。已发现各种抗帕金森病药物及其制剂，如缓释左旋多巴-卡比多巴和普拉克索，相对于其他药物具有成本效益。最新的抗帕金森病药物，儿茶酚-O-甲基转移酶抑制剂，也有可能改善HRQL和经济结局，尽管还需要更多研究来证实这一点。只有在除临床结局外还考察HRQL和经济结局时，才能充分认识到PD及其治疗的总体影响。
