The Price to Pay. An economic model of Parkinson’s disease

(October 2018)

Multiple studies describe progression, dementia rates, direct and indirect costs, and health utility by Hoehn and Yahr (H&Y) stage, but research has not incorporated these data into a model to evaluate possible economic consequences of slowing progression. This study aimed to model the course of Parkinson’s disease (PD) and describe the economic consequences of slower rates of progression. A Markov model was developed to show the net monetary benefits of slower rates of progression. Four scenarios assuming hypothetical slower rates of progression were compared to a base case scenario. A systematic literature review identified published longitudinal H&Y progression rates. Direct and indirect excess costs (i.e., healthcare costs beyond what similar patients without PD would incur), mortality rates, dementia rates, and health utility were derived from the literature. Ten publications (N = 3,318) were used to model longitudinal H&Y progression. Base case results indicate average excess direct costs of $303,754, life years of 12.8 years, and quality-adjusted life years of 6.96. A scenario where PD progressed 20% slower than the base case resulted in net monetary benefits of $60,657 ($75,891 including lost income) per patient. The net monetary benefit comes from a $37,927 decrease in direct medical costs, a 0.45 increase in quality-adjusted life-years, and $15,235 decrease in lost income. The scenario where PD progression was arrested resulted in net monetary benefits of $442,429 per patient. Reducing progression rates could produce significant economic benefits. This benefit is strongly dependent on the degree to which progression is slowed.
Worldwide, there is concern that increases in the prevalence of dementia will result in large demands for caregivers and supportive services that will be challenging to address. Previous dementia projections have either been simple extrapolations of prevalence or macro simulations based on dementia incidence.
In a population-based microsimulation model of Alzheimer’s and related dementias (POHEM:Neurological), Canadian demographic data was employed. It estimates dementia incidence, health status (health-related quality of life and mortality risk), health care costs, and informal caregiving use. Dementia prevalence and 12 other measures were projected to 2031. Thus, between 2011 and 2031, there was a projected two-fold increase in the number of people living with dementia in Canada (a 1.6-fold increase in prevalence rate). By 2031, the projected informal (unpaid) caregiving for dementia in Canada was two billion hours per year or 100 h per year per Canadian of working age. The projected increase in dementia prevalence was largely related to the expected increase in older Canadians, with projections sensitive to changes in the age of dementia onset.

More and more Americans living with Alzheimer’s – as many as 16 million by 2050, when there will be nearly one million new cases each year. Due to these projected increases, the graying of America threatens the bankrupting of America. Caring for people with Alzheimer’s will cost all payers – Medicare, Medicaid, individuals, private insurance, and HMOs — $20 trillion over the next 40 years, enough to pay off the national debt and still send a $10,000 check to every man, woman, and child in America. In 2012, America will have spent an estimated $200 billion in direct costs for those with Alzheimer’s, including $140 billion in costs to Medicare and Medicaid.
Average per person Medicare costs for those with Alzheimer’s and other dementias are three times higher than those without these conditions. Average per senior Medicaid spending is 19 times higher.

On the other side, patients with Parkinson’s disease (PD) experience progressive disability and reduced quality of life due to both motor and non-motor complications. The cost of illness escalates as PD progresses, placing an economic burden on the healthcare system, society, and patients themselves. Overall cost estimates vary from country to country, but the largest component of direct cost is typically inpatient care and nursing home costs, while prescription drugs are the smallest contributor. Indirect costs arising from lost productivity and carer burden tend to be high. The total cost in the UK has been estimated to be between pound 449 million and pound 3.3 billion annually, depending on the cost model and prevalence rate used. Management strategies that minimize the impact of disease progression and maximize the quality of life should help ensure optimal resource utilization.

To evaluate the potential economic benefits of early rule-out of AD, annual medical resource use and costs for Medicare beneficiaries potentially misdiagnosed with AD before their diagnosis of vascular dementia (VD) or Parkinson’s disease (PD) were compared with that of similar patients never diagnosed with AD.
Patients with prior AD diagnosis used substantially more medical services every year until their VD/PD diagnosis, resulting in incremental annual medical costs of approximately $9,500-$14,000. However, following their corrected diagnosis, medical costs converged with those of patients never diagnosed with AD.
The observed correlation between the timing of correct diagnosis and subsequent reversal in excess costs is strongly suggestive of the role of misdiagnosis of AD – rather than AD comorbidity – in this patient population. Our findings suggest potential benefits from an earlier, accurate diagnosis.

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