Epidemiology and burden

Parkinson’s disease

1
Prevalence of Parkinson’s disease

2
Parkinson’s disease is a widespread public health issue

• PD is recognised as the second-most common Cost per case of specific brain disorders in Europe 8
neurodegenerative disorder1 Cost per patient (€)
• Approximately 6 million people are diagnosed 0 10,000 20,000 30,000 40,000
with Parkinson’s disease (PD) worldwide2,3 Tumour
• In Europe, there are an estimated Multiple sclerosis
1.2 million people with PD3 Stroke
• PD affects 1–2 per 1,000 of the population4,5 Dementia
• PD affects 1% of the population over the age of Psychotic disorder
60, but is rare in individuals younger than 50 Parkinson’s disease
years 4,6
Epilepsy
• The prevalence of PD rises with age, and in the Affective disorders
oldest age groups, PD reaches a prevalence of
approximately 4%4,7 Trauma
Addiction
Anxiety disorders
1. Bertram & Tanzi. J Clin Invest 2005;115(6):1449–1457; Migraine
2. European Parkinson’s Disease Association website. Accessed Feb 2017;
3. GBD 2015. Lancet 2016;388:1545–602; 4. Tysnes & Storstein. J Neural Transm 2017;124:901–905;
5. von Campenhausen et al. Eur Neuropsychopharmacol 2005;15(4):473–490; 6. de Lau & Breteler. Lancet Neurol 2006;5(6):525–535;
7. Zou et al. Eur Rev Med Pharmacol Sci 2014;18(24):3908–3915; 8. Andlin-Sobocki et al. Eur J Neurol 2005;12(Suppl 1):1–27 3
Prevalence of Parkinson’s disease in the USA

• Prevalence describes the • Estimates vary, but there are

number of people with a given approximately 1 million people in
condition at a given time (often the USA living with PD2
expressed per 100,000 people)1

• Incidence rates describe the • The incidence rate in the USA has
number of new cases of a given been approximated to be 13.4 per
condition arising over a given 100,0003
time, usually per year, often • This rate rises rapidly over the age
expressed per 100,000 people1 of 60 years3

1. Oxford Concise Medical Dictionary. 2007;

2. Michael J. Fox foundation website. Accessed Feb 2017;
3. Van Den Eeden et al. Am J Epidemiol 2003;157(11):1015–1022 4
Prevalence of Parkinson’s disease in Europe

• A meta-analysisa comparing studies • This meta-analysis identified

estimating the prevalence of PD in
various European countries gave
prevalence rates of 108–257 per
100,000 people1
• When considering only older
people (>60 years old) this rate
increased to 1,280–1,500 per
100,000 people 1
several problems which may give
rise to the variation in estimates:1
• Differences in methodology
• Differences in diagnostic criteria
• Differences in the type and design of
the surveys
• Variations in age categories (i.e., some
surveys stop at >75 years whereas
some stop at >90 years old)

The prevalence of PD is difficult to measure; however, the disease

is more commonly found in older individuals
a
A meta-analysis is a study using data from several other studies

1. von Campenhausen et al. Eur Neuropsychopharmacol 2015;15:473–490 5

 Prevalence of Parkinson’s disease in China

Comparison of age-specific prevalence of PD in Zou et al. 2014 China survey

community-based surveys in China (adapted from Zou et al., 2014 1)
5 29 provinces, China, 1991

Ilan county, Taiwan, 2001

4
Three cities, China, 2005
Prevalence (%)

Keelung, Taiwan, 2009

3

2 The prevalence of PD in China

continues to rise after 80
years of age; the overall rates
1 are similar to other countries
and regions1

0
55 60 65 70 75 80 85 90 95
Age (years)

1. Zou et al. Eur Rev Med Pharmacol Sci 2014;18(24):3908–3915 6

Prevalence of Parkinson’s disease by age

• In a meta-analysis of worldwide Prevalence of PD by age and geographic location

(per 100,000 people)1
data, the prevalence of PD
increased with age, from 41 per Age range (years)
Location
100,000 people in individuals 50–59 60–69 70–79 80+
40–49 years to 1,903 per 100,000
people in individuals ≥801 South America 228 637 2,180 6,095
• Comparing regions of the world,
Europe/
Asia had a lower prevalence than North America/ 113 540 1,602 2,953
other areas at all ages studied1 Australia

Asia 88 376 646 1,418

1. Pringsheim et al. Movement Dis 2014;29(13):1583–1590 7

Prevalence of Parkinson’s disease by sex

• In a meta-analysis of worldwide Prevalence of PD by sex and geographic location

(per 100,000 people)1
data, in the 50–59 age group,
males had a significantly increased
Location Female Male
prevalence of PD of 134 per
100,000 people relative to females,
with a prevalence of PD of 41 per South America 808 1,267
100,000 people (p<0.05)1
Europe/
North America/ 1,267 1,535
Australia

The prevalence of PD was greater Asia 306 371

amongst men than women1

1. Pringsheim et al. Movement Dis 2014;29(13):1583–1590 8

Predictions of the increase in Parkinson’s disease prevalence

• Based on an analysis of epidemiological The predicted increased prevalence of PD in

data in Western Europe’s 5 most and the individuals over 50 years old1

Number of individuals with PD (millions)

5
world’s 10 most populous nations,a it was China
estimated that the prevalence of PD in Europe
individuals over 50 years of age would rise 4
from 4.1 million people in 2005, to 8.7
million people by 20301 3
• The burden of PD is expected to grow
substantially, and to become increasingly 2
concentrated outside the Western world1
1

0
2005 2010 2015 2020 2025 2030
Year
a
Europe: Germany, France, UK, Italy and Spain
The world: China, India, USA, Indonesia, Brazil, Pakistan, Bangladesh, Russia, Nigeria, Japan

1. Dorsey et al. Neurology 2007;68(5):384–386 9

Risk factors associated with Parkinson’s disease

Risk factors1,2 Protective factors1,2

• Age • Smoking/tobacco use
• Sex • Caffeine
• Genetics • Urate
• Pesticide exposure • Physical activity
• Dairy • NSAIDsa
• Melanoma • Calcium channel blockers
• Traumatic brain injury

The risk of developing PD is a balance of the effect of positive and negative

factors on the genetic predisposition of an individual2
a
Strongest evidence for ibuprofen, for other NSAIDs the evidence is mixed or poor;1,2 NSAID=nonsteroidal anti-inflammatory drug

1. Lee & Gilbert. Neurol Clin 2016;34(4):955–965;

2. Ascherio & Schwarzschild. Lancet Neurol 2016;15(12):1257–1272 10
The burden of Parkinson’s disease

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The economic burden of Parkinson’s disease

• In a study estimating the economic Breakdown of PD-related costs1

burden of PD in the USA between Inpatient care
1999–2002:1 19.9%
• Direct costs: $10,349 per patient Uncompensated Outpatient
care care
• Indirect costs: $25,326 per patient 18.8% 7.5%
• Total cost to the US: $23.0 billion per
year Prescription
drugs
• Outpatient care and drug costs 4.4%
accounted for a relatively small
proportion of the economic burden1
Productivity loss
49.4%
By far the largest share of
the cost (49.4% of the total)
is due to productivity loss1

1. Huse et al. Mov Disord 2005;20(11):1449–1454 12

The indirect costs of Parkinson’s disease

• Indirect costs are the expenses • In one analysis within the USA, the
incurred from the cessation or indirect costs of PD represented
reduction of work productivity as a 45% of the total excess costsa
result of the morbidity and mortality within the first year after diagnosis2
associated with a given disease1 • In several studies analysing the
• Indirect costs include:1,2 costs of PD, the indirect costs were
• Work loss greater than the direct costs3-5
• Worker loss and replacement
• Lost/reduced productivity
• Absenteeism (habitual absence from
work)

a
Excess costs defined as costs incurred by patients with PD minus the total incurred by a control population

1. Boccuzzi. In: Cardiovascular Health Care Economics. 2003;

2. Johnson et al. Pharmacoeconomics 2013;31(9):779–806; 3. Martinez-Martín et al. PLoS One 2015;10(12):e0145310;
4. Huse et al. Mov Disord 2005;20:1449–1454; 5. Boland & Stacy. Am J Manag Care 2012;18(7 Suppl):S168–175 13
The costs of hospitalisation

In the English National Health Direct costs of PD in the UK2,3

System, an analysis of hospital 5,000

Cost of PD per patient per year (£)

admissions between April 2009 National Health System
and March 2013 showed:1 4,000 Social services

• 324,055 PD-related hospital Private expenditure

3,000
admissions
• The costs of non-elective 2,000
PD-related hospital admissions
1,000
totalled £777 million
• These costs were driven largely 0
<65 65–74 75–84 >85
by admissions for pneumonia or
for PD itself Age (years)

1. Low et al. Parkinsonism Relat Disord 2015;21(5):449–454;

2. Findley. Parkinsonism Relat Disord 2007;13:S8–S12;
3. Findley et al. Mov Disord 2003;18(10):1139–1145 14
The increasing economic burden of Parkinson’s disease

Costs of PD over 4 years • An analysis within the Spanish

4,000 health system estimated the costs
Indirect costs
of PD during 4 years1
Direct costs
3,000 • Direct costs increased by 52% from
year 1–41
Costs (€)

2,000 • Indirect costs increased by 129%1

1,000
Costs increased with the
progression and the severity
0
0 1 2 3 4 of the disease1
Years

1. Martinez-Martín et al. PLoS One 2015;10(12):e0145310 15

The predicted burden of Parkinson’s disease in the future

• In 2010, an estimated 630,000 people in the Medical costs of PD over time1

United States had clinically-diagnosed PD1
10
• Population projections suggest that the
number of people diagnosed with PD will Self/family Commerical
8
increase to 1.34 million by 20501 Medicaid/public Medicare

Medical cost of PD
(in 2010 billion $)
• This translates to an increase in medical 6
costs from an estimated $8 billion in 2010
to >$18 billion in 20501 4

2
The prevalence of PD in the USA is likely
to double between 2010 and 20401 0
2010 2020 2030 2040 2050

Year
Medicaid=a US programme that helps with medical costs for some people with limited income;2
Medicare=a US programme that pays for hospital and medical care for elderly and certain disabled Americans;2
Commercial=money paid by commercial health insurance agencies1

1. Kowal et al. Mov Disord 2013;28(3):311–318; 2. Medicare website. https://www.medicare.gov/. Accessed Mar 2017 16
The burden of Parkinson’s disease on the patient

• PD has a substantial impact on quality of life, driven by:

• Motor symptoms1
• Non-motor symptoms such as depression – roughly half of patients with PD suffer from some
form of depression, but this is typically under-treated1,2
• Treatment-related side effects and complications – e.g., psychosis, excessive daytime
somnolence, impulse control disorders, dyskinesia, and motor fluctuations3,4
• In studies of US veterans:
• Health-related quality of life scores among patients with PD were found to be lower than for all
other diseases studieda – except spinal cord injury and depression2
• Scores on the UPDRS (Unified Parkinson’s Disease Rating Scale; a scale which measures the
severity of PD) correlated with quality of life indices5

Including congestive heart failure, stroke, chronic low back pain, arthritis, diabetes, and angina/coronary heart disease
a

1. Boland & Stacy. Am J Manag Care 2012;18(7 Suppl):S168–175; 2. Gage et al. J Neurol Neurosurg Psychiatry 2003;74(2):163–169;
3. Jankovic & Aguilar. Neuropsychiatr Dis Treat 2008;4(4):743–757; 4. Chapuis et al. Mov Disord 2005;20(2):224–230;
5. Kleiner-Fisman et al. Health Qual Life Outcomes 2010;8:91 17
The burden of non-motor symptoms on the patient

Correlation between non-motor symptoms

• Neuropsychiatric symptoms, including
and quality of life scores
depression, anxiety, apathy, fatigue and
(adapted from Duncan et al., 20142)
psychosis (hallucinations and/or delusions) are
common in patients with PD1

Quality of Life Questionnaire

Worsening score on the PD
• A questionnaire study assayed the effect of
non-motor symptoms on quality of life for
patients with PD2
• Many non-motor symptoms correlated with
quality of life scores:2
• Depression
• Anxiety
• Impaired concentration Increasing number of
• Memory complaints non-motor symptoms
• Sleep disturbance
There was a significant correlation between the total number of
non-motor symptoms reported and quality of life2
PDQ=Parkinson’s Disease Quality of Life Questionnaire

1. Aarsland et al. Mov Disord 2009;24(15):2175-2186; 2. Duncan et al. Mov Disord 2014;29(2):195–202 18
The burden of Parkinson’s disease on caregivers

• Caregivers of patients with PD are Patient-related variables that impact on

almost always relatives, and are the caregiver:1
often elderly1 • Disability • Motor symptoms
• Caring for a patient with PD places • PD symptoms • Medical
• Disease duration comorbidities
a considerable burden on the • Neuropsychiatric
caregiver1 • Higher medical
costs symptoms
• Caregiver burdens include:2 • Gait impairment (including cognitive
•
impairment,
Health problems • Use of psychosis, apathy,
• Modification of habits antidepressants depression, and
• Economic loss • Postural instability impulse control
• Deterioration of quality of life and falls disorders)3
• Quality of life

1. Peters. Focus on PD 2014;24(1):44–48;

2. Martinez-Martin et al. Expert Rev Pharmacoecon Outcomes Res 2012;12(2):221–230;
3. Aarsland et al. J Neurol Neurosurg Psychiatry 2007;78(1):36–42 19
The burden of the cognitive symptoms of Parkinson’s disease on caregivers

• The level of cognitive functioning of patients can pose particular

challenges to the caregivers of patients with PD1
• One study showed that individuals who are more cognitively impaired
place a greater burden on caregivers:1
• The poorest quality of life was reported by caregivers of patients with PD dementia
• Impairments to a patient’s attention, memory, and executive function (e.g., the ability to plan and
solve problems) showed a strong relationship with caregiver burden
• Attentional deficits were the strongest predictor of caregiver quality of life compared with other
cognitive factors
• Loss of attention in patients with PD may lead to increased caregiver responsibilities
(to compensate for the attentional deficit), leading to reduced quality of life of the caregiver

1. Lawson et al. Int J Geriatr Psychiatry 2017;32(12):1362-1370 20

“
Parkinson’s disease is a disease
with growing prevalence and
negative effects on quality of life

Boland & Stacy. Am J Manag Care 2012;18(7 Suppl):S168–175 21