Impact of motor and non-motor symptoms on the direct costs of Parkinson's disease

Introduction. We evaluate the health-related economic burden of patients with Parkinson's disease (PD) and identify the impact of motor and nonmotor symptoms (NMS) and health-related quality of life (HRQL) on the direct costs of PD in Spain. Method. A cross-sectional, multicenter, pilot study covering consecutive PD outpatients who were included during the year 2004. Cognition (MMSE, SCOPA-Cog), autonomic dysfunction (SCOPA-AUT), motor impairment, severity and complications (SCOPA-motor), depression/anxiety (HADS), sleep (PDSS), psychosis (PPRS), pain, severity/global impairment (HY staging and CISI-PD) and health-related quality of life (EuroQoL) were evaluated. PD-related cost data were obtained using a standardized questionnaire. Association of clinical variables with direct costs was analyzed using the parametric and nonparametric tests. Results. Seventy-eight consecutive PD outpatients (52 010 female and 48% male) having a mean age of 68.2 years (SD: 11), median HY stage of 2 (1-5), and mean PD duration of 8.3 years (SD: 5.4) were included in this study. Average 3 month total direct cost of PD was (sic)2,631 (SD: 4507) per person (range: (sic)71.5-(sic) 29,159) and medical treatment was the main cost driver, accounting for 34% (mean drug cost per person 669; SD: 406). PD direct costs were significantly higher among younger patients, with higher HY stage, PD duration, severity, motor impairment and motor complications (p<0.05). Conclusions. Disease severity, motor impairment and complications had a higher impact on the direct costs of PD than NMS.