Dodel R C, Eggert K M, Singer M S, Eichhorn T E, Pogarell O, Oertel W H
Department of Neurology, Ludwig-Maximilians-Universität, München, Germany.
Mov Disord. 1998 Mar;13(2):249-54. doi: 10.1002/mds.870130209.
Parkinson's disease (PD) has a major socioeconomic impact on society. The chronic, progressive course of the disease, which often leads to severe disability, results in high expenses for the medical resources used for treatment, care, and rehabilitation of patients as well as reduced or lost productivity as a result of illness or premature death. In Great Britain, it has been estimated that the National Health Service spends up to 383 million pound sterling (1992) annually for the care of PD. This emphasizes the importance of assessing the costs related to this disease. A detailed knowledge of the cost allocation would provide a solid basis on which health care priorities can be rationally set. Next to hospitalization, drug treatment accounts for the highest expense for direct medical costs of PD. Therefore, this analysis focuses on the costs of drug treatment for PD. The cost analysis was based on a retrospective study of 409 patients with PD who were seen over a 1-year period in our movement disorders clinic. The cost of therapy varied considerably depending on the severity of the condition (assessed in the "off" phase), the incidence of motor fluctuations, and the type of PD. In the early stage of the disease (Hoehn and Yahr stage I [HY I]), mean daily costs for therapy were DM (German marks) 6.60, which increased in later stages of the disease (HY V) to DM 22.00. If rare cases requiring continuous subcutaneous apomorphine infusion were included, mean daily costs of patients in HY V rose to DM 32.50 (the mean daily costs of subcutaneous apomorphine-treated patients in HY V: DM 74.30). Patients with motor fluctuations accounted for higher costs (DM 16.50) compared with those without motor fluctuations (DM 7.80). With respect to the three subtypes of PD, the mean daily expenditure was DM 7.00 for the tremor-dominant type, DM 12.40 for the akinetic-rigid type, and DM 10.80 for the mixed type. In the group of 409 PD patients included in this analysis, the average daily expenditure for drug treatment totaled DM 10.70 per patient (including patients on subcutaneous apomorphine).
帕金森病（PD）对社会有着重大的社会经济影响。该疾病的慢性、进行性病程常常导致严重残疾，造成用于患者治疗、护理和康复的医疗资源费用高昂，同时由于患病或过早死亡导致生产力下降或丧失。在英国，据估计国民医疗服务体系每年用于PD护理的费用高达3.83亿英镑（1992年）。这凸显了评估与该疾病相关成本的重要性。对成本分配的详细了解将为合理确定医疗保健重点提供坚实基础。除住院治疗外，药物治疗在PD的直接医疗成本中占比最高。因此，本分析聚焦于PD的药物治疗成本。成本分析基于对409例PD患者的回顾性研究，这些患者在我们的运动障碍门诊接受了为期1年的观察。治疗成本因病情严重程度（在“关”期评估）、运动波动发生率以及PD类型的不同而有很大差异。在疾病早期（Hoehn和Yahr分期I [HY I]），治疗的日均成本为6.60德国马克，在疾病后期（HY V）增至22.00德国马克。如果将需要持续皮下注射阿扑吗啡的罕见病例包括在内，HY V期患者的日均成本升至32.50德国马克（HY V期接受皮下阿扑吗啡治疗患者的日均成本：74.30德国马克）。有运动波动的患者成本（16.50德国马克）高于无运动波动的患者（7.80德国马克）。就PD的三种亚型而言，震颤为主型的日均支出为7.00德国马克，运动不能-强直型为12.40德国马克，混合型为10.80德国马克。在本分析纳入的409例PD患者组中，药物治疗的人均日均支出总计为10.70德国马克/患者（包括接受皮下阿扑吗啡治疗的患者）。
