Social and economic cost of L-Dopa-induced dyskinesias in patients with Parkinson's disease.

Long term L-Dopa medication mainly induces two complications in Parkinson's Disease (PD) patients, ie. motor fluctuations and dyskinesias. Both of these complications can significantly impair the patient's quality of life. At a high degree of severity, dyskinesias can interfere with everyday tasks, balance, speech, etc. From a clinical point of view, they lead to complicated L-Dopa dose adjustments or to the use of sustained release forms. For these reasons, L-Dopa-induced dyskinesias may have a significant human and financial impact We have designed a retrospective study to explore two aspects of PD, i.e. the impact of dyskinesias on patient's social life and their economic cost Ten French neurologists were randomly selected from a national file to participate in this study. They were asked to include 4 patients with PD currently under L-Dopa medication and showing 4 different levels of dyskinesia severity, i.e. absent, moderate, mild and severe dyskinesia, according to the Unified Parkinson Disease Rating Scale, with no other specific inclusion criteria. Two specific scales were to be completed, Hoehn & Yahr on disease severity and Schwab & England on degree of independence. Clinical profiles of patients, demographics and use of medical resources were also recorded, investigators were interviewed about their practice. This study showed that patients with dyskinesias had an earlier onset of the disease (11.2 years vs. 3.7 years). They also had a higher level of disease severity, according to the Hoehn & Yahr scale (40p. cent vs. Op. cent presenting a level of 4). The mean monthly cost was significantly higher for patients with dyskinesias (FF 3 733 versus FF 1 109, p = 0.0005). Particularly, the presence of dyskinesias had a significant impact on treatment costs and medical visits. A positive gradient of the medical cost with level of dyskinesia severity was also underlined. In the same way, the more severe the dyskinesia status the greater the need for caregivers. Finally, based on these results, the total annual medical cost of dyskinesias in France was estimated between 588 and 812 million francs.