Parkinson's Disease Medication Use and Costs Following Deep Brain Stimulation
Identifieur interne : 001035 ( Main/Exploration ); précédent : 001034; suivant : 001036Parkinson's Disease Medication Use and Costs Following Deep Brain Stimulation
Auteurs : Frances M. Weaver [États-Unis] ; Kevin T. Stroupe [États-Unis] ; LISHAN CAO [États-Unis] ; Robert G. Holloway [États-Unis] ; Barbara G. Vickrey [États-Unis] ; Tanya Simuni [États-Unis] ; Ann Hendricks [États-Unis] ; Dolores Ippolito [États-Unis]Source :
- Movement disorders [ 0885-3185 ] ; 2012.
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- Pascal (Inist)
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Abstract
The costs of treating Parkinson's disease (PD) are significant. Medication reductions usually occur following deep brain stimulation (DBS), but less is known about the relative costs of DBS targets, the globus pallidum (GPi) or the subthalamic nucleus (STN). This article reports medication costs between best medical therapy (BMT) and DBS over 6 months postintervention and by DBS target over 36 months postsurgery. Prescription use and costs for patients (n = 161) with advanced PD from a multisite randomized trial of BMT and DBS were examined overall and by drug category. Medication adjustment occurred at the discretion of the neurologists. PD medications were extracted from the Department of Veterans Affairs Decision Support System database. Levodopa equivalents (LEDD) were significantly lower for DBS than for BMT patients at 6 months (1101 vs 1398 mg; P = .005), but costs were similar (US$1750 vs US$1589; P = .55). LEDD decreased following GPi and STN DBS (1395-1161 mg, P = .014; and 1347-891 mg, P < .0001, respectively) in the first 6 months, but was lower for STN than for GPi over 36 months following DBS (P = .03). Total PD medication costs per 6-month intervals decreased over 36 months (P <.0001), but did not differ by target (P = .50) in the mixed-model analysis. However, cumulative medication costs over 36 months were lower for the STN than for GPi patients. PD medication use and costs decreased following DBS in either target over 36 months, but cumulative costs were less for STN than for GPi.
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Weaver</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Hines VA Hospital, Center for Management of Complex Chronic Care</s1><s2>Hines, Illinois</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Illinois</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Loyola University Stritch School of Medicine</s1><s2>Maywood, Illinois</s2><s3>USA</s3><sZ>1 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Illinois</region></placeName></affiliation></author><author><name sortKey="Stroupe, Kevin T" sort="Stroupe, Kevin T" uniqKey="Stroupe K" first="Kevin T." last="Stroupe">Kevin T. Stroupe</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Hines VA Hospital, Center for Management of Complex Chronic Care</s1><s2>Hines, Illinois</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Illinois</region></placeName></affiliation></author><author><name sortKey="Lishan Cao" sort="Lishan Cao" uniqKey="Lishan Cao" last="Lishan Cao">LISHAN CAO</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Hines VA Hospital, Center for Management of Complex Chronic Care</s1><s2>Hines, Illinois</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Illinois</region></placeName></affiliation></author><author><name sortKey="Holloway, Robert G" sort="Holloway, Robert G" uniqKey="Holloway R" first="Robert G." last="Holloway">Robert G. Holloway</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>University of Rochester Medical Center</s1><s2>Rochester, New York</s2><s3>USA</s3><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Vickrey, Barbara G" sort="Vickrey, Barbara G" uniqKey="Vickrey B" first="Barbara G." last="Vickrey">Barbara G. Vickrey</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>VA Greater Los Angeles Healthcare System, VA Southwest PADRECC</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation><affiliation wicri:level="2"><inist:fA14 i1="05"><s1>UCLA Department of Neurology</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Simuni, Tanya" sort="Simuni, Tanya" uniqKey="Simuni T" first="Tanya" last="Simuni">Tanya Simuni</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Northwestern University, Parkinson's Disease and Movement Disorders Center</s1><s2>Chicago, Illnois</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Chicago, Illnois</wicri:noRegion></affiliation></author><author><name sortKey="Hendricks, Ann" sort="Hendricks, Ann" uniqKey="Hendricks A" first="Ann" last="Hendricks">Ann Hendricks</name><affiliation wicri:level="2"><inist:fA14 i1="07"><s1>VA Boston Healthcare System, Health Care Financing & Economics</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Ippolito, Dolores" sort="Ippolito, Dolores" uniqKey="Ippolito D" first="Dolores" last="Ippolito">Dolores Ippolito</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Hines VA Hospital, Center for Management of Complex Chronic Care</s1><s2>Hines, Illinois</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Illinois</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Chemotherapy</term><term>Cost efficiency analysis</term><term>Costs</term><term>Deep brain stimulation</term><term>Nervous system diseases</term><term>Parkinson disease</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Chimiothérapie</term><term>Coût</term><term>Analyse coût efficacité</term><term>Stimulation cérébrale profonde</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The costs of treating Parkinson's disease (PD) are significant. Medication reductions usually occur following deep brain stimulation (DBS), but less is known about the relative costs of DBS targets, the globus pallidum (GPi) or the subthalamic nucleus (STN). This article reports medication costs between best medical therapy (BMT) and DBS over 6 months postintervention and by DBS target over 36 months postsurgery. Prescription use and costs for patients (n = 161) with advanced PD from a multisite randomized trial of BMT and DBS were examined overall and by drug category. Medication adjustment occurred at the discretion of the neurologists. PD medications were extracted from the Department of Veterans Affairs Decision Support System database. Levodopa equivalents (LEDD) were significantly lower for DBS than for BMT patients at 6 months (1101 vs 1398 mg; P = .005), but costs were similar (US$1750 vs US$1589; P = .55). LEDD decreased following GPi and STN DBS (1395-1161 mg, P = .014; and 1347-891 mg, P < .0001, respectively) in the first 6 months, but was lower for STN than for GPi over 36 months following DBS (P = .03). Total PD medication costs per 6-month intervals decreased over 36 months (P <.0001), but did not differ by target (P = .50) in the mixed-model analysis. However, cumulative medication costs over 36 months were lower for the STN than for GPi patients. PD medication use and costs decreased following DBS in either target over 36 months, but cumulative costs were less for STN than for GPi.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li><li>Illinois</li><li>Massachusetts</li><li>État de New York</li></region></list><tree><country name="États-Unis"><region name="Illinois"><name sortKey="Weaver, Frances M" sort="Weaver, Frances M" uniqKey="Weaver F" first="Frances M." last="Weaver">Frances M. Weaver</name></region><name sortKey="Hendricks, Ann" sort="Hendricks, Ann" uniqKey="Hendricks A" first="Ann" last="Hendricks">Ann Hendricks</name><name sortKey="Holloway, Robert G" sort="Holloway, Robert G" uniqKey="Holloway R" first="Robert G." last="Holloway">Robert G. Holloway</name><name sortKey="Ippolito, Dolores" sort="Ippolito, Dolores" uniqKey="Ippolito D" first="Dolores" last="Ippolito">Dolores Ippolito</name><name sortKey="Lishan Cao" sort="Lishan Cao" uniqKey="Lishan Cao" last="Lishan Cao">LISHAN CAO</name><name sortKey="Simuni, Tanya" sort="Simuni, Tanya" uniqKey="Simuni T" first="Tanya" last="Simuni">Tanya Simuni</name><name sortKey="Stroupe, Kevin T" sort="Stroupe, Kevin T" uniqKey="Stroupe K" first="Kevin T." last="Stroupe">Kevin T. Stroupe</name><name sortKey="Vickrey, Barbara G" sort="Vickrey, Barbara G" uniqKey="Vickrey B" first="Barbara G." last="Vickrey">Barbara G. Vickrey</name><name sortKey="Vickrey, Barbara G" sort="Vickrey, Barbara G" uniqKey="Vickrey B" first="Barbara G." last="Vickrey">Barbara G. Vickrey</name><name sortKey="Weaver, Frances M" sort="Weaver, Frances M" uniqKey="Weaver F" first="Frances M." last="Weaver">Frances M. Weaver</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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