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INTRODUCTION: Parkinson's disease, whose prevalence in Colombia is 4.7 per 1,000 inhabitants, is a public health problem and a therapeutic challenge for health professionals. OBJECTIVE: To determine the prescribing patterns of antiparkinson drugs and the variables associated with its use in a population from Colombia. MATERIALS AND METHODS: We conducted a descriptive cross-sectional study. We selected patients who had been given antiparkinson drugs uninterruptedly between January 1st and March 31st, 2015 from a systematized database of approximately 3.5 million people affiliated to the Colombian health system. We included sociodemographic, pharmacologic and comedication variables. For the multivariate analysis, we used the IBM SPSS™-22 software. RESULTS: A total of 2,898 patients was included; the mean age was 65.1years, and 50.7% were men; 69.4% (n=2010) of people received monotherapy and 30.6% combination therapy with two to five antiparkinson drugs. The most frequently prescribed drugs were: levodopa 45.5% (n=1,318 patients), biperiden 23.1% (670), amantadine 18.3% (531) and pramipexole 16.3% (471). The most commonly used association was levodopa/carbidopa + entacapone (n=311; 10.7%). Multivariate analysis showed that being male (OR=1.56; 95%CI: 1.321-1.837), over 60 years (OR=1.41; 95%CI 1.112-1.782) and receiving treatment in the city of Barranquilla (OR=2.23; 95%CI 1.675-2.975) were statistically associated with a greater risk of using combination therapy; 68.2% (n=1,977) patients were given concomitant treatment with other drugs. CONCLUSIONS: Prescribing habits of drugs with high therapeutic value predominated, mainly in antiparkinson drugs monotherapy. Most were employed in the usual recommended doses. It is necessary to explore the clinical effectiveness of the medications studied and differentiate between disease and parkinsonian syndromes subtypes.
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Antiparkinsonianos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiparkinsonianos/classificação , Antiparkinsonianos/economia , Colômbia , Comorbidade , Estudos Transversais , Custos de Medicamentos , Quimioterapia Combinada , Uso de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/economia , Polimedicação , Adulto JovemRESUMO
BACKGROUND: Parkinson disease (PD) is a chronic multifaceted neurodegenerative disorder of adult onset that affects quality of life and places a burden on patients, caregivers, and society. In early disease, dopaminergic therapy improves motor symptoms, but as the disease progresses, symptoms tend to increase in frequency and severity, even with best medical treatment (BMT). Deep brain stimulation (DBS) becomes an option for certain patients, but cost becomes an important issue. OBJECTIVE: We performed a systematic review of the literature of economic studies of the use of DBS in patients with PD, including costs studies or economic evaluations expressed as cost per improvement in quality life, decrease in dose of pharmacological treatments, and the decrease of caregiver burden. METHODS: We reviewed the following databases: Medline/PubMed, Embase, Cochrane Database of Systematic Reviews, LILACS, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform ICTRP portal and ClinicalTrials.gov from 1980 to 2015. Costs have been converted or adjusted to 2016 US dollars (US$). RESULTS: Nine studies were identified. The average cost of DBS for a patient with PD in 5 years is US$186,244. The quality-adjusted life year was higher in DBS compared with BMT after at least 2 years of treatment, with an average incremental cost utility ratio of US$41,932 per additional quality-adjusted life year gained. Costs in the first year are higher with DBS because of direct costs related to the surgical procedure, the device, and the more frequent controls. Studies show better results with a longer time horizon (up to 5 years). CONCLUSION: DBS is a cost-effective intervention for patients with advanced PD, but it has a high initial cost compared with BMT. However, DBS reduces pharmacologic treatment costs and should also reduce direct, indirect, and social costs of PD on the long term.
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Cuidadores/economia , Efeitos Psicossociais da Doença , Estimulação Encefálica Profunda/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Doença de Parkinson/economia , Doença de Parkinson/terapia , Antiparkinsonianos/economia , Antiparkinsonianos/uso terapêutico , Cuidadores/estatística & dados numéricos , Terapia Combinada/economia , Terapia Combinada/estatística & dados numéricos , Análise Custo-Benefício/economia , Análise Custo-Benefício/estatística & dados numéricos , Estimulação Encefálica Profunda/estatística & dados numéricos , Humanos , Internacionalidade , Doença de Parkinson/mortalidade , Prevalência , Qualidade de Vida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: To assess disability and healthcare resource use in Parkinson's disease (PD) patients. METHODS: A cross-sectional survey of 144 Brazilian PD patients consecutively admitted at a Neurological outpatient clinic. Clinical evaluation was done using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn & Yahr staging (H&Y). The Schwab and England (SE) activity of daily living (ADL) scale was used to assess the level of dependence in the ADL. Information about the utilization of health resources was obtained interviewing the patient by means of a structured questionnaire. RESULTS: A total of 66% of patients (mean age 62 years; males, 53%) had a Hoehn & Yahr stage < or = 2. Mean UPDRS score was 46.2, and median SE scale score was 80. Disabled PD patients significantly received more visits by a general practitioner (p < 0.001). Patients with comorbid conditions significantly used more domiciliary nurse care and physiotherapist assistance (p < 0.01). The most frequent reason for hospitalization was the treatment of clinical complications and drug dose adjustment. Pharmacological treatment costs were associated with the severity of the disease (p < 0.05). CONCLUSION: Utilization of healthcare resources was influenced by functional status and comorbid conditions.
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Efeitos Psicossociais da Doença , Serviços de Saúde/estatística & dados numéricos , Doença de Parkinson/epidemiologia , Atividades Cotidianas , Antiparkinsonianos/economia , Antiparkinsonianos/uso terapêutico , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Custos de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Doença de Parkinson/economia , Aceitação pelo Paciente de Cuidados de Saúde , Médicos de Família , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Background: The high costs of adequate pharmacological treatment for Parkinson disease preclude the universal access of patients to this medication. Aim: To assess the accessibility to pharmacological treatment of Chilean patients with Parkinson disease. Patients and methods: An inquiry about socioeconomic stratification, medical controls, disease features and costs of pharmacological therapy, was applied to 95 patients (56 male, aged 32 to 89 years old) attending the Chilean League Against Parkinson Disease. Results: Among studied patients, the disease had a mean duration of 7.9ñ6 years. There was a direct relationship between family income, the frequency of visits to physicians and the dose and cost of pharmacological therapy. Conclusions: The accessibility to pharmacological therapy among patients with Parkinson disease, depends on their socioeconomic level. Measures to correct this situation and improve the quality of life of these patients should be undertaken by health services
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/epidemiologia , Antiparkinsonianos/economia , Classe Social , Levodopa/efeitos adversos , Custos de Medicamentos/estatística & dados numéricos , Efeitos Psicossociais da Doença , Renda , Enquete SocioeconômicaRESUMO
BACKGROUND: The high costs of adequate pharmacological treatment for Parkinson disease preclude the universal access of patients to this medication. AIM: To assess the accessibility to pharmacological treatment of Chilean patients with Parkinson disease. PATIENTS AND METHODS: An inquiry about socioeconomic stratification, medical controls, disease features and costs of pharmacological therapy, was applied to 95 patients (56 male, aged 32 to 89 years old) attending the Chilean League Against Parkinson Disease. RESULTS: Among studied patients, the disease had a mean duration of 7.9 +/- 6 years. There was a direct relationship between family income, the frequency of visits to physicians and the dose and cost of pharmacological therapy. CONCLUSIONS: The accessibility to pharmacological therapy among patients with Parkinson disease, depends on their socioeconomic level. Measures to correct this situation and improve the quality of life of these patients should be undertaken by health services.