Objective: To prospectively evaluate the health economic burden of patients with Parkinson's disease (PD) in Germany over a 6-month observation period and to identify the predictors of these costs. Study design and methods: Direct and indirect costs were evaluated in 145 patients with PD (mean age 67.3 +- 9.6 years). PD patients were recruited from an outpatient department for movement disorders, a specialised PD clinic, two office-based neurologists and general practitioners, all located in Germany, and were enrolled between January and June 2000. Relevant economic data were documented in a patient diary over the 6-month period. Clinical evaluations (Unified Parkinson's Disease Rating Scale [UPDRS]) were performed at baseline and at 3 and 6 months. Costs were derived from various German medical economic resources. Costs were calculated from the perspective of healthcare and transfer payment providers and the individual patient. Indirect costs for lost productivity were also calculated. Costs are presented as means +- standard deviation (SD). Multivariate regression analyses were performed to identify independent cost predictors. Costs are in year 2000-02 values. Results: We estimated average per patient direct, indirect and total costs for the 6-month observation period. The costs from the perspective of statutory health insurance (Gesetzliche Krankenkversicherung [GKV]) consisted of direct medical costs _1370 +- _3240, including rehabilitation (_420 +- _1630), hospitalisation (_710 +- _2520), outpatient treatment (_40 +- _30), ancillary treatment (_190 +- _280) and ambulatory diagnostic procedures (_10 +- _30). In addition, parkinsonian drug costs were _1520 +- _1250. Non-medical direct costs calculated from the GKV perspective were estimated to be _480 +- _1710, which included transportation (_10 +- _20), special equipment (_420 +- _1640), social/home-help services (_10 +- _110) and sickness benefit (_40 +- _540). The total medical (including drug costs) and non-medical direct costs for the GKV were _3380 +- _4230. Univariate predictors for GKV direct costs included occurrence of motor complications and falls, disease severity, nightmares and dementia. However, multivariate analyses only suggested disease severity and health-related quality of life as significant predictors. For nursing insurance, payments of _1330 +- _2890 were calculated. For retirement insurance, payments were _650 +- _1510 and there were patient (or caregiver) costs of _1490 +- _2730. Total indirect costs amounted to _3180 +- _6480. Conclusion: According to our study, PD puts a high financial burden on society and underscores the need for further economic and medical research to optimise treatment for PD.
