scholarly journals Экономическая эффективность доклинической диагностики болезни Паркинсона: марковская модель

2020 ◽  
pp. 129-148
Author(s):  
Сергей Вартанов ◽  
Ирина Богатова ◽  
Ирина Денисова ◽  
Валериан Кучеряну ◽  
Наталья Турдыева ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Risk Group ◽  
Pharmacoeconomic Analysis ◽  
Open Data ◽  
Preventive Treatment ◽  
Economic Effects ◽  
Economic Determinants ◽  
Life Years ◽  
The Cost

Работа посвящена фармакоэкономическому анализу результатов внедрения ранней (доклинической) диагностики болезни Паркинсона в России. На основе совокупности социально-экономических детерминант и панели биомаркеров крови может оказаться возможным выделение среди всей популяции «группы риска» людей, с наибольшей вероятностью склонных к возникновению паркинсонизма либо уже больных им на доклинической стадии. Вкупе с традиционно используемым в фармакоэкономике хронических и продолжительных заболеваний подходом, основанным на представлении динамики развития болезни с помощью марковских цепей – дискретных случайных процессов без памяти – это делает возможным анализ экономических эффектов от раннего выявления заболевших и проведения профилактической доклинической терапии. В работе исследована марковская модель болезни Паркинсона, состоящая из восьми состояний – пять состояний, соответствующих стадиям HY1-HY5, два доклинических состояния («группа риска», «продромальное состояние»). Используя в качестве исходных данных для модели вероятности перехода между состояниями и оценки качества жизни, скорректированные с учетом здоровья (HRQoL), опубликованные в ряде работ аффилированных с корпорацией AbbVie исследователей, и рассчитав затраты на терапию на основе открытых данных о стоимости лекарств и процедур на российском рынке (eapteka, apteka.ru, piluli.ru, сайт Минздрава РФ), в работе показано, что за счет внедрения доклинической диагностики и проведения профилактического лечения на доклинических стадиях выявленным пациентам возможно значительно увеличить среднее время дожития (в годах, скорректированных по качеству жизни) по сравнению со стандартной терапией, а средние затраты на одного пациента до конца жизни – значительно снизить. This article contains a pharmacoeconomic analysis of early (preclinical) diagnosis of Parkinson's disease in Russia. Previous works show that using a combination of socio-economic determinants and a panel of blood biomarkers one may distinguish a Parkinsonism-related “risk group” among the entire population. This group consists of people who are most vulnerable to parkinsonism or are already ill, but at the preclinical stage. Together with the approach traditionally used in the pharmacoeconomics of chronic and long-term diseases, based on the representation of the dynamics of the development of the disease using Markov chains - discrete random processes without memory - this makes it possible to analyze the economic effects of early detection of cases and conducting preventive preclinical therapy. The work investigates the Markov model of Parkinson's disease, consisting of nine states - five states corresponding to the stages HY1-HY5, two preclinical states ("risk group", "prodromal state"). We use as the initial data for the model the probability of transition between states and health-adjusted quality of life (HRQoL) estimates, published in a number of works of researchers affiliated with AbbVie Corporation, and calculate the cost of therapy based on open data on the cost of drugs and procedures in Russian market. Moreover, we show that due to the introduction of preclinical diagnostics and preventive treatment at preclinical stages, identified patients can significantly increase the average survival time (in quality-adjusted life-years) compared to standard therapy, and the average cost per patient until the end of life can be significantly reduced.

Pharmacoeconomic Analysis of Using Sinemet CR over Standard Sinemet in Parkinsonian Patients with Motor Fluctuations

1998 ◽  
Vol 32 (9) ◽  
pp. 878-883 ◽  
Author(s):  
Alan G Hempel ◽  
Mary L Wagner ◽  
Mohamed A Maaty ◽  
Jacob I Sage
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Tertiary Care ◽  
Motor Fluctuations ◽  
University Teaching ◽  
Total Cost ◽  
Medication Costs ◽  
The Cost

OBJECTIVE: To compare the costs of pharmacotherapy in patients with Parkinson's disease before and after converting from standard Sinemet to extended-release Sinemet CR. DESIGN: Investigators retrospectively reviewed records of patients converting from Sinemet to Sinemet CR for efficacy and total drug costs. Cost-effectiveness was evaluated retrospectively from data collected in prospective Sinemet CR efficacy trials. SETTING: Parkinson's disease clinic at a tertiary care university teaching hospital. PATIENTS: 100 patients with motor fluctuations who had undergone an initial 6-month course of Sinemet therapy, followed by a 6-month course of Sinemet CR. MAIN OUTCOME MEASURES: Total cost was measured as the cost of Sinemet formulations plus the costs of other antiparkinson medications. Differences in pre- and postconversion costs were compared by using the paired, two-tailed Student's t-test. A substudy of 39 patients on the cost-effectiveness of conversion measured the ratio of daily medication costs to the daily hours “on” without chorea. RESULTS: While total daily medication costs after conversion increased by 21%, patients experienced either a comparable or an improved degree of disease control with Sinemet CR. Patients who were also taking selegiline were able to decrease selegiline expense by 20%. The costs of other adjunctive medications did not differ significantly after conversion. The cost-effectiveness analysis revealed an increase in postconversion on time by 2.2 hours (p = 0.0001), accompanied by a $2.85 decrease in total cost per hour on without chorea (p = 0.11). CONCLUSIONS: Although Sinemet CR is more costly, it may be more cost-effective in patients with motor fluctuations. Some patients may be able to reduce adjunctive medications.

scholarly journals The cost-effectiveness of levodopa/carbidopa intestinal gel compared to standard care in advanced Parkinson’s disease

2017 ◽  
Vol 20 (11) ◽  
pp. 1207-1215 ◽  
Author(s):  
Julia Lowin ◽  
Kavita Sail ◽  
Rakhi Baj ◽  
Yash J. Jalundhwala ◽  
Thomas S. Marshall ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cost Effectiveness ◽  
Standard Care ◽  
Advanced Parkinson’S Disease ◽  
The Cost

scholarly journals Dopamine-dependent loss aversion during effort-based decision-making

2019 ◽  
Author(s):  
Xiuli Chen ◽  
Sarah Voets ◽  
Ned Jenkinson ◽  
Joseph M. Galea
Keyword(s):  
Parkinson’S Disease ◽  
Decision Making ◽  
Parkinson's Disease ◽  
Loss Aversion ◽  
Brain Regions ◽  
Decision Making Under Risk ◽  
Physical Effort ◽  
Clinical Disorders ◽  
The One ◽  
The Cost

AbstractFrom psychology to economics there has been substantial interest in how costs (e.g., delay, risk) are represented asymmetrically during decision-making when attempting to gain reward or to avoid punishment. For example, in decision-making under risk, individuals show a tendency to prefer to avoid punishment than to acquire the equivalent reward (loss aversion). Although the cost of physical effort has received significant recent attention due to the evaluation of motor costs being crucial in our daily decisions, it remains unclear whether loss aversion exists during effort-based decision-making. On the one hand, loss aversion may be hardwired due to asymmetric evolutionary pressure on losses and gains and therefore exists across decision-making contexts. On the other hand, distinct brain regions are involved with different decision costs, making it questionable whether similar asymmetries exist. Here, we demonstrate that young healthy participants exhibit loss aversion during effort-based decision-making by exerting more physical effort in order to avoid punishment than to gain a same-size reward. Next, we show that medicated Parkinson’s disease (PD) patients show a reduction in loss aversion compared to age-matched controls. Behavioural and computational analysis revealed that people with PD exerted similar physical effort in return for a reward, but were less willing to produce effort in order to avoid punishment. Therefore, loss aversion is present during effort-based decision-making and can be modulated by altered dopaminergic state. This finding could have important implications for our understanding of clinical disorders that show a reduced willingness to exert effort in the pursuit of reward.Significance StatementLoss aversion – preferring to avoid punishment than to acquire equivalent reward – is an important concept in decision-making under risk. However, little is known about whether loss aversion also exists during decisions where the cost is physical effort. This is surprising given that motor cost shapes human behaviour, and a reduced willingness to exert effort is a characteristic of many clinical disorders. Here, we show that healthy individuals exert more effort to minimise punishment than to maximise reward (loss aversion). We also demonstrate that loss aversion is modulated by altered dopaminergic state by showing that medicated Parkinson’s disease patients exert similar effort to gain reward but less effort to avoid punishment. Therefore, dopamine-dependent loss aversion is crucial for explaining effort-based decision-making.

scholarly journals 80. Pharmacoeconomic Analysis Comparing the Empiric Utilization of Cefepime Versus Piperacillin/tazobactam

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
Kelsey Olmack ◽  
Curtis D Collins
Keyword(s):  
Pharmacoeconomic Analysis ◽  
Hospital Setting ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Decision Analytic Model ◽  
Empiric Treatment ◽  
Life Years ◽  
The Cost ◽  
The Impact

Abstract Background In the hospital setting, cefepime (CFP) and piperacillin/tazobactam (PTZ) are among the most commonly utilized antipseudomonal agents in the empiric treatment of nosocomial and healthcare-associated infections. Institutional preference of CFP or PTZ as the preferred antipseudomonal antibiotic varies. Recent literature suggests each may be associated with increased rates of harmful adverse effects including Clostridiodes difficile infection (CDI) and acute kidney injury (AKI). The objective of this study is to perform a pharmacoeconomic analysis comparing CFP versus PTZ for empiric antibiotic treatment in patients where Pseudomonas aeruginosa is a concern. Methods We performed a cost-utility analysis comparing CFP and PTZ for empiric utilization in the hospital setting by creating a decision analytic model from the hospital perspective. Model variables were populated utilizing published clinical and economic data including incidence of AKI and CDI, their associated costs and mortality, and the cost of antibiotic therapy. Secondary and univariate sensitivity analyses tested the impact of model uncertainties and the robustness of our model. A willingness to pay (WTP) threshold of $0 was utilized. Results Results of our base-case model predicted that the use of CFP dominated PTZ as empiric utilization was less expensive ($7690 vs. $9331) and associated with a higher quality-adjusted life-years (QALY) (0.9193 vs. 0.9191) compared to the use of PTZ. Several variables had the potential to impact base case results. PTZ became cost-effective at our WTP threshold if CFP nephrotoxicity rates increased to 17.3%, the PTZ nephrotoxicity decreased to 28.5%, or if the cost of nephrotoxicity was less than $17,457. No other model variables, including incidence of CDI, impacted base case results. Sensitivity Analysis on Cefepime Clostridioides difficile Infection Incidence and Piperacillin/tazobactam Nephrotoxicity Conclusion Results of our model showed that CFP dominated PTZ for the empiric treatment of nosocomial infections. The model was sensitive to variation in CFP and PTZ nephrotoxicity rates. Disclosures All Authors: No reported disclosures

scholarly journals The Cost-Effectiveness of specialized Nursing Interventions for people with Parkinson’s Disease: the NICE-PD study protocol for a randomized controlled clinical trial

2019 ◽  
Author(s):  
Danique LM Radder ◽  
Herma H Lennaerts ◽  
Hester Vermeulen ◽  
Thies van Asseldonk ◽  
Cathérine CS Delnooz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cost Effectiveness ◽  
Controlled Clinical Trial ◽  
Motor Symptoms ◽  
Randomized Controlled Clinical Trial ◽  
Randomized Controlled ◽  
The Cost

Abstract Background Current guidelines recommend that every person with Parkinson’s disease (PD) should have access to Parkinson’s Disease Nurse Specialist (PDNS) care. However, there is little scientific evidence on the cost-effectiveness of PDNS care. This hampers wider implementation, creates unequal access to care and possibly leads to avoidable disability and costs. Therefore, we aim to study the (cost-)effectiveness of specialized nursing care provided by a PDNS compared to usual care (without PDNS) for people with PD in all disease stages. To gain more insight into the deployed interventions and their effects, a pre-planned subgroup analysis will be performed based on disease duration (diagnosis <5, 5-10, or >10 years ago). Methods We will perform an 18-month, single-blind, randomized controlled clinical trial in eight community hospitals in the Netherlands. A total of 240 people with PD that have not been treated by a PDNS over the past two years will be included, independent of disease severity or duration. In each hospital, 30 patients will randomly be allocated in a 1:1 ratio to either care by a PDNS (who works according to a recent guideline on PDNS care) or usual care. We will use two co-primary outcomes: quality of life (measured with the Parkinson’s Disease Questionnaire-39) and motor symptoms (measured with the MDS-UPDRS part III). Secondary outcomes include non-motor symptoms, health-related quality of life, experienced quality of care, self-management, medication adherence, caregiver burden and coping skills. Data will be collected after 12 months and 18 months by a blinded researcher. A healthcare utilization and productivity loss questionnaire will be completed every 3 months. Discussion The results of this trial will have an immediate impact on the current care of people with PD. We hypothesize that, by offering more patients access to PDNS care, quality of life will increase. We also expect healthcare costs to remain equal, as increases in direct medical costs (funding additional nurses) will be offset by a reduced number of consultations with the general practitioner and neurologist. If these outcomes are reached, wide implementation of PDNS care is warranted. Trial registration ClinicalTrials.gov: NCT03830190. Registered February 5, 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03830190.

The Cost of Parkinson’s Disease: A Systematic Review

2019 ◽  
pp. 183-193
Author(s):  
Sávio Luís Oliveira da Silva ◽  
Oswaldo Luiz Gonçalves Quelhas ◽  
Julio Vieira Neto ◽  
Marco Antônio Araújo Leite
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
The Cost

Precued Shifting of Attention between Cognitive Sets in Parkinson Patients

1996 ◽  
Vol 78 (3) ◽  
pp. 815-823 ◽  
Author(s):  
Shulan Hsieh ◽  
Wen-Juh Hwang ◽  
Jing-Jane Tsai ◽  
Chin-Yi Tsai
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Reaction Time ◽  
Control Group ◽  
Benefit Analysis ◽  
Cost And Benefit ◽  
Component Processes ◽  
Cost And Benefit Analysis ◽  
The Cost ◽  
Normal Controls

The precueing paradigm developed by Posner has been used to examine visuospatial shifting of attention. In the current study, we modified such a paradigm so that it could be studied in nonvisuospatial domains and its component processes of disengagement, movement, and engagement could be analyzed in a similar fashion to the visuospatial domains. 14 patients with Parkinson's disease and 14 normal controls matched for age, sex, handedness, and years of education served as subjects. The speed of shifting attention was measured using the cost and benefit analysis. Analyses showed an over-all slowness in reaction time of patients with Parkinson's disease compared to the control group but without a concomitant slowness to engage, shift, and disengage their attention.

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