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      Prevalence and Cost of Care for Parkinson’s Disease in Luxembourg: An Analysis of National Healthcare Insurance Data

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          Abstract

          Background

          Parkinson’s disease (PD) is the second most common neurodegenerative disorder, with an increasing prevalence worldwide. Estimates of the economic burden associated with PD vary widely across existing studies due to differences in setting and study design. The prevalence and cost of care for PD in Luxembourg are currently unknown.

          Objective

          The aims of this study were to estimate (1) the prevalence of PD in Luxembourg and (2) the cost of care for PD to the national healthcare insurance based on routinely collected healthcare data.

          Methods

          This analysis was based on individual patient-level data collected by the national healthcare insurance in Luxembourg during 2007–2017, which covers over 95% of the resident population. People with PD were identified based on drug reimbursement profiles. Cost of care was estimated according to a comparative analysis of the healthcare resources consumed by people with PD compared with an age- and sex-matched control group.

          Results

          We determined a PD prevalence of 928 per 100,000 individuals aged 50 years and older in 2016, higher in men (1032 per 100,000) than in women (831 per 100,000). The total mean cost of care for PD was estimated at €22,673 per patient per year in 2016, with the highest costs being associated with long-term care (69%).

          Conclusion

          This was the first attempt to estimate the prevalence and cost of care of PD in Luxembourg. The work demonstrated the usefulness of routinely collected data in Luxembourg for such analyses. Our study confirms the significant burden of PD to the healthcare system, especially on long-term care.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s41669-021-00321-3.

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          Most cited references40

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          Global, regional, and national burden of Parkinson's disease, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

          E Dorsey, Alexis Elbaz, Emma Nichols … (2019)
          Summary Background Neurological disorders are now the leading source of disability globally, and ageing is increasing the burden of neurodegenerative disorders, including Parkinson's disease. We aimed to determine the global burden of Parkinson's disease between 1990 and 2016 to identify trends and to enable appropriate public health, medical, and scientific responses. Methods Through a systematic analysis of epidemiological studies, we estimated global, regional, and country-specific prevalence and years of life lived with disability for Parkinson's disease from 1990 to 2016. We estimated the proportion of mild, moderate, and severe Parkinson's disease on the basis of studies that used the Hoehn and Yahr scale and assigned disability weights to each level. We jointly modelled prevalence and excess mortality risk in a natural history model to derive estimates of deaths due to Parkinson's disease. Death counts were multiplied by values from the Global Burden of Disease study's standard life expectancy to compute years of life lost. Disability-adjusted life-years (DALYs) were computed as the sum of years lived with disability and years of life lost. We also analysed results based on the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings In 2016, 6·1 million (95% uncertainty interval [UI] 5·0–7·3) individuals had Parkinson's disease globally, compared with 2·5 million (2·0–3·0) in 1990. This increase was not solely due to increasing numbers of older people, because age-standardised prevalence rates increased by 21·7% (95% UI 18·1–25·3) over the same period (compared with an increase of 74·3%, 95% UI 69·2–79·6, for crude prevalence rates). Parkinson's disease caused 3·2 million (95% UI 2·6–4·0) DALYs and 211 296 deaths (95% UI 167 771–265 160) in 2016. The male-to-female ratios of age-standardised prevalence rates were similar in 2016 (1·40, 95% UI 1·36–1·43) and 1990 (1·37, 1·34–1·40). From 1990 to 2016, age-standardised prevalence, DALY rates, and death rates increased for all global burden of disease regions except for southern Latin America, eastern Europe, and Oceania. In addition, age-standardised DALY rates generally increased across the Socio-demographic Index. Interpretation Over the past generation, the global burden of Parkinson's disease has more than doubled as a result of increasing numbers of older people, with potential contributions from longer disease duration and environmental factors. Demographic and potentially other factors are poised to increase the future burden of Parkinson's disease substantially. Funding Bill & Melinda Gates Foundation.
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            Parkinson's disease: clinical features and diagnosis.

            J. Jankovic (2008)
            Parkinson's disease (PD) is a progressive neurological disorder characterised by a large number of motor and non-motor features that can impact on function to a variable degree. This review describes the clinical characteristics of PD with emphasis on those features that differentiate the disease from other parkinsonian disorders. A MedLine search was performed to identify studies that assess the clinical characteristics of PD. Search terms included "Parkinson's disease", "diagnosis" and "signs and symptoms". Because there is no definitive test for the diagnosis of PD, the disease must be diagnosed based on clinical criteria. Rest tremor, bradykinesia, rigidity and loss of postural reflexes are generally considered the cardinal signs of PD. The presence and specific presentation of these features are used to differentiate PD from related parkinsonian disorders. Other clinical features include secondary motor symptoms (eg, hypomimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing, dystonia, glabellar reflexes), non-motor symptoms (eg, autonomic dysfunction, cognitive/neurobehavioral abnormalities, sleep disorders and sensory abnormalities such as anosmia, paresthesias and pain). Absence of rest tremor, early occurrence of gait difficulty, postural instability, dementia, hallucinations, and the presence of dysautonomia, ophthalmoparesis, ataxia and other atypical features, coupled with poor or no response to levodopa, suggest diagnoses other than PD. A thorough understanding of the broad spectrum of clinical manifestations of PD is essential to the proper diagnosis of the disease. Genetic mutations or variants, neuroimaging abnormalities and other tests are potential biomarkers that may improve diagnosis and allow the identification of persons at risk.
            Article 0 comments Cited 679 times – based on 0 reviews     Review now
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              Epidemiology of Parkinson's disease

              Lonneke ML de Lau, Monique Breteler (2006)
              The causes of Parkinson's disease (PD), the second most common neurodegenerative disorder, are still largely unknown. Current thinking is that major gene mutations cause only a small proportion of all cases and that in most cases, non-genetic factors play a part, probably in interaction with susceptibility genes. Numerous epidemiological studies have been done to identify such non-genetic risk factors, but most were small and methodologically limited. Larger, well-designed prospective cohort studies have only recently reached a stage at which they have enough incident patients and person-years of follow-up to investigate possible risk factors and their interactions. In this article, we review what is known about the prevalence, incidence, risk factors, and prognosis of PD from epidemiological studies.
              Article 0 comments Cited 544 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Susanne Schmitz:
                ORCID: http://orcid.org/0000-0003-4753-1709
                SusanneSchmitz779@gmail.com
                Journal
                Journal ID (nlm-ta): Pharmacoecon Open
                Journal ID (iso-abbrev): Pharmacoecon Open
                Title: PharmacoEconomics Open
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 2509-4262
                ISSN (Electronic): 2509-4254
                Publication date (Electronic): 16 January 2022
                Publication date PMC-release: 16 January 2022
                Pages: 1-10
                Affiliations
                [1 ]GRID grid.451012.3, ISNI 0000 0004 0621 531X, Competence Center for Methodology and Statistics, Department of Population Health, , Luxembourg Institute of Health, ; 1a-b Rue Thomas Edison, 1445 Strassen, Luxembourg
                [2 ]GRID grid.414980.0, ISNI 0000 0000 9401 2774, Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, , Jewish General Hospital, ; Montreal, QC Canada
                [3 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, Department of Neurology and Neurosurgery, , McGill University, ; Montreal, QC Canada
                [4 ]Caisse Nationale de Santé, Luxembourg, Luxembourg
                [5 ]GRID grid.451012.3, ISNI 0000 0004 0621 531X, Department of Population Health, , Luxembourg Institute of Health, ; Strassen, Luxembourg
                [6 ]GRID grid.16008.3f, ISNI 0000 0001 2295 9843, Clinical and Experimental Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), , University of Luxembourg, ; Esch-sur-Alzette, Luxembourg
                [7 ]GRID grid.418041.8, ISNI 0000 0004 0578 0421, Parkinson’s Research Clinic, , Centre Hospitalier de Luxembourg (CHL), ; Luxembourg, Luxembourg
                [8 ]GRID grid.451012.3, ISNI 0000 0004 0621 531X, Transversal Translational Medicine, , Luxembourg Institute of Health, ; Strassen, Luxembourg
                [9 ]GRID grid.16008.3f, ISNI 0000 0001 2295 9843, Luxembourg Centre for Systems Biomedicine, Translational Neuroscience, , University of Luxembourg, ; Luxembourg, Luxembourg
                [10 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, Department of Epidemiology, Biostatistics, and Occupational Health, , McGill University, ; Montreal, Québec Canada
                Author information
                http://orcid.org/0000-0003-4753-1709
                Article
                Publisher ID: 321
                DOI: 10.1007/s41669-021-00321-3
                PMC ID: 8761379
                PubMed ID: 35034346
                SO-VID: dc44cf95-7f64-4d53-aa26-7199b9223016
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date accepted : 16 December 2021
                Funding
                Funded by: Fonds National de la Recherche Luxembourg
                Award ID: FNR/P13/6682797
                Award Recipient :
                Categories
                Subject: Original Research Article

                Data availability:

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