1
|
Chaudhuri KR, Hand A, Obam F, Belsey J. Cost-effectiveness analysis of the Parkinson's KinetiGraph and clinical assessment in the management of Parkinson's disease. J Med Econ 2022; 25:774-782. [PMID: 35593687 DOI: 10.1080/13696998.2022.2080437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS The Parkinson's KinetiGraph (PKG) is a wrist-worn movement recording system that collates continuous, objective, data during daily activities in people with Parkinson's disease (PD) providing a report for clinicians. This study explores the cost-effectiveness of adding the PKG to routine PD assessments. METHODS A de novo Markov model of three health states: uncontrolled, controlled and death compared PKG plus routine assessment by a Movement Disease Specialist (MDS) versus routine assessment. Uncontrolled and controlled states were based on the Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS) II and III scores. The transition between health states was dependent on improvement in MDS-UPDRS II and III, and transition to death state on all cause-mortality and PD-specific relative mortality risk. Markov cycle length was yearly beyond year 1 and lifetime horizon 22 years. LIMITATIONS PKG evidence incorporated in this analysis is based on findings from one clinical trial. Health state utilities were mapped and the probability of patients progressing from uncontrolled to controlled health state at the second visit and beyond was derived from a bootstrap method which assumed a normal distribution for MDS-UPDRS. RESULTS The addition of the PKG to usual PD assessments is a cost-effective intervention. PKG plus routine assessment is associated with lower total costs compared to routine assessment (£141,950 versus £159,312) and improved quality-adjusted life years (7.88 versus 7.61), resulting in an incremental cost-effectiveness ratio of -£64,978.99 and a net monetary benefit of £22,706.37 using a £20,000 threshold. Results were robust across sensitivity and scenario analyses. CONCLUSIONS Management of PD involves monitoring and evaluation of symptoms to assess disease progression and ensure appropriate treatment choices. Adding the PKG to clinical assessment in routine care allows for improved and objective identification of PD motor symptoms which can be used in clinical decision making to improve patient outcomes.
Collapse
Affiliation(s)
- K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, and. Parkinson's Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Annette Hand
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom
| | - Fallon Obam
- JB Medical Ltd, Sudbury, Suffolk, United Kingdom
| | | |
Collapse
|
2
|
Santos García D, de Deus Fonticoba T, Cores Bartolomé C, Naya Ríos L, García Roca L, Martínez Miró C, Canfield H, Jesús S, Aguilar M, Pastor P, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LM, McAfee D, Martinez-Martin P, Mir P. Predictors of Loss of Functional Independence in Parkinson's Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up and Comparison with a Control Group. Diagnostics (Basel) 2021; 11:1801. [PMID: 34679503 PMCID: PMC8534700 DOI: 10.3390/diagnostics11101801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/19/2021] [Accepted: 09/26/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to compare the progression of independence in activities of daily living (ADL) in Parkinson's disease (PD) patients versus a control group, as well as to identify predictors of disability progression and functional dependency (FD). PATIENTS AND METHODS PD patients and control subjects, who were recruited from 35 centers of Spain from the COPPADIS cohort between January 2016 and November 2017 (V0), were included. Patients and subjects were then evaluated again at the 2-year follow-up (V2). Disability was assessed with the Schwab & England Activities of Daily Living Scale (S&E-ADLS) at V0 and V2. FD was defined as an S&E-ADLS score less than 80%. RESULTS In the PD group, a significant decrease in the S&E-ADLS score from V0 to V2 (N = 507; from 88.58 ± 10.19 to 84.26 ± 13.38; p < 0.0001; Cohen's effect size = -0.519) was observed but not in controls (N = 124; from 98.87 ± 6.52 to 99.52 ± 2.15; p = 0.238). When only patients considered functional independent at baseline were included, 55 out of 463 (11.9%) converted to functional dependent at V2. To be a female (OR = 2.908; p = 0.009), have longer disease duration (OR = 1.152; p = 0.002), have a non-tremoric motor phenotype at baseline (OR = 3.574; p = 0.004), have a higher score at baseline in FOGQ (OR = 1.244; p < 0.0001) and BDI-II (OR = 1.080; p = 0.008), have a lower score at baseline in PD-CRS (OR = 0.963; p = 0.008), and have a greater increase in the score from V0 to V2 in UPDRS-IV (OR = 1.168; p = 0.0.29), FOGQ (OR = 1.348; p < 0.0001) and VAFS-Mental (OR = 1.177; p = 0.013) (adjusted R-squared 0.52; Hosmer and Lemeshow test = 0.94) were all found to be independent predictors of FD at V2. CONCLUSIONS In conclusion, autonomy for ADL worsens in PD patients compared to controls. Cognitive impairment, gait problems, fatigue, depressive symptoms, more advanced disease, and a non-tremor phenotype are independent predictors of FD in the short-term.
Collapse
Affiliation(s)
- Diego Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | | | - Carlos Cores Bartolomé
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Lucía Naya Ríos
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Lucía García Roca
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Cristina Martínez Miró
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Hector Canfield
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (C.C.B.); (L.N.R.); (L.G.R.); (C.M.M.); (H.C.)
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41009 Seville, Spain; (S.J.); (P.M.)
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, Terrassa, 08221 Barcelona, Spain; (M.A.); (P.P.)
| | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, 08221 Barcelona, Spain; (M.A.); (P.P.)
| | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, 08970 Barcelona, Spain;
| | - Inés Legarda
- Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain;
| | - Jorge Hernández Vara
- Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain; (J.H.V.); (O.d.F.)
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), 36071 Pontevedra, Spain; (I.C.); (M.S.)
| | | | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
- Hospital Universitario Marqués de Valdecilla, 39011 Santander, Spain
| | - María A. Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L’Hospitalet, L’Hospitalet de Llobregat, 08906 Barcelona, Spain;
| | | | | | | | - Julio Dotor
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | | | - Berta Solano Vila
- Institut d’Assistència Sanitària (IAS)—Institut Català de la Salut, 17190 Girona, Spain;
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, 28922 Madrid, Spain;
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), 43500 Tarragona, Spain;
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, 09006 Burgos, Spain;
| | | | | | | | - Maria G. Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), 36213 Vigo, Spain;
| | | | - Itziar Gastón
- Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
- Hospital de Sant Pau, 08041 Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), 36071 Pontevedra, Spain; (I.C.); (M.S.)
| | | | | | | | - Oriol de Fábregues
- Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain; (J.H.V.); (O.d.F.)
| | | | | | | | - Luis M. López Díaz
- Complejo Hospitalario Universitario de Orense (CHUO), 32005 Orense, Spain;
| | - Darrian McAfee
- Laboratory for Cognition and Neural Stimulation, Univeristy of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41009 Seville, Spain; (S.J.); (P.M.)
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | | |
Collapse
|