Health Economics

Parkinson’s disease (PD) mainly affects the elderly. The number of patients is continually growing due to the ageing of the population. Considering the rising expenses for the health-care, it is therefore likely that health economic research will increasingly provide a decision-making framework. In the context of Parkinson's disease, decision-makers in Europe have little current information on optimal strategies for allocating resources in this area. Only a few studies for PD have been presented (Bain et al. 2000, Chrischilles et al. 1998, Dodel et al. 1998, Haycock et al. 1995, Hoerger et al. 1998, LePen et al. 1999, Rubenstein et al. 1997, Whettens-Goldstein et al. 1997). Some data on expenses for Parkinson’s disease in one year are available for some countries:

  • USA: $ 14.3 billion (Whetten-Goldstein et al. 1997)
  • Germany: $ 1.0 billion (Dodel et al. 1998)
  • France: $ 411 million (LePen et al. 1999)
  • UK: $ 280 million (Haycock et al. 1995)
  • Sweden: $ 136 million (Hagell et al. 2002)

The lack of significant studies is in contrast to other neurological diseases, such as Alzheimer's disease and epilepsy where detailed economic data are available. As a part of EuroPa, the health economics project will be one of the first health care utilization studies of Parkinson's disease on an European level.

The project is divided into 3 steps:

  1. Descriptive analysis of how care of PD is organised in Europe
  2. Comparative analysis of burden-of-disease, health-related quality of life and patient preferences (utilities) of PD in Europe
  3. Establishment of a review board for health research of PD patients in Europe

Step 1: Descriptive analysis of how care of PD is organised in Europe

The aim of the first analysis is to highlight the different European health system structures involved in the care of PD in most of the participating countries: Austria, Czech Republic, France, Germany, Italy, The Netherlands, Portugal, Spain, Sweden, United Kingdom.

Getting an overview of the existing decision making processes is important to understand the consequences of these processes on the care of PD patients as basis for interpretation of health-economic data from a national as well as an European perspective.


A structured database search was conducted. Search parameters were identified as keywords, which correspond to the information requirements defined. Grey literature was hand searched and the reference lists of identified studies and reviews examined. Additionally research via telephone and Internet has been conducted. National institutes for statistics, third party payers, national medical societies, PD specialists, ministries of health, various national and international organisations and support groups were contacted for information on national care of PD.
Reviewed data: Definition of PD, epidemiology, national treatment guidelines and treatment patterns, in-patient days, rehabilitation, institutionalisation, home care, disease management programs and availability of support groups.


Detailed information on PD care is not easily accessible in Europe, despite the importance of the disease. Epidemiological data are available for most of the investigated countries, except for the Czech Republic and Austria. The studies differ considerably regarding study design and criteria of diagnosis for PD which is commonly reported as reason for differences in prevalence. The graphic gives an overview of epidemiological studies in the investigated countries.

Pharmacological treatment is not standardised and varies depending on the patient’s age, disease stage and age of disease onset. Recommendations for initial therapy in PD differ within the countries. Detailed data on treatment patterns, however, are scarce.
PD rehabilitation is differently organised in the European countries: in The Netherlands and France no Parkinson specific rehabilitation centres are available, in contrast to other countries like Germany or Italy. However, paucity of data precludes a detailed statement.
While in Germany and other European countries no disease management programs exist, the UK PD society is developing a network of PD specialist nurses to co-ordinate multidisciplinary care. Support groups have been established in all investigated countries.
Future activities:
Step 1: A report of the descriptive analysis how care of PD is organised in Europe is almost finalised and will be reviewed by country experts. An epidemiological survey of Parkinson's Disease in respect of the investigated countries will be provided.
Step 2: The study on the cost-of-care, health-related quality of life and patients’ preferences of PD in Europe is in preparation. The investigation plan as well as the questionnaires are drafted and will be provided to the participating centres for review in March 2003. After finalisation of study documents the study will be initiated and patients can become included. Results of the cost-of-care study are supposed to be presented by the end of 2003.
Step 3: Establishment of a review board for health research of PD patients in Europe.


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