The Use of Decision-Analytic Models in Parkinson's Disease

By Shearer, James; Green, Colin et al. | Applied Health Economics and Health Policy, July 2011 | Go to article overview

The Use of Decision-Analytic Models in Parkinson's Disease


Shearer, James, Green, Colin, Counsell, Carl E., Zajicek, John P., Applied Health Economics and Health Policy


Parkinson's disease (PD) is a chronic neurodegenerative disorder affecting approximately 1% of the population aged >60 years worldwide, with a rising prevalence with age.[1] The progressive course of PD is associated with increasing morbidity and mortality. Disease progression in PD is caused by ongoing degeneration of dopaminergic and other neurons, characterized by symptoms of resting tremor, rigidity, bradykinesia (slowness of movement) and postural instability.[2] In the absence of recognized, reliable biological markers, disease states and disease progression in PD have been defined and measured by the presence and/or severity of motor symptoms. The natural history of PD is also characterized by an increasing incidence of non-motor symptoms, including dementia, depression, behavioural problems and sleep disorders, and autonomic dysfunction, such as gastrointestinal and genitourinary problems.[3]

There are currently no interventions that prevent or modify the lifelong progression of PD. Many PD motor symptoms can initially be controlled by dopamine replacement therapy using medications such as levodopa, which is converted into dopamine in the brain. However, long-term use of levodopa is associated with motor fluctuations (fluctuating periods of motor performance where the tremor, rigidity and bradykinesia recur at times such as end-of-dose 'wearing off' or random 'on/off' fluctuations) and dyskinesias (jerky, involuntary movements) that eventually add to the burden of PD. Non-pharmacological approaches are also available to manage the motor and non-motor symptoms of PD. These include surgical stimulation of brain neurons, rehabilitation, physiotherapy, occupational therapy, speech therapy and behavioural and psychological interventions.[4]

The physical disability, morbidity and psychosocial difficulties associated with disease progression in PD negatively impact the health-related quality of life (HR-QOL) of people with PD. As populations age, PD is expected to represent an increasingly significant healthcare burden on individuals and healthcare systems.[5] Against the growing demand for healthcare and support from those with PD, it is inevitable that future health technology developments (as well as existing health technologies) for PD will be subject to scrutiny due to healthcare resource constraints and difficult priority-setting conditions.

Cost-effectiveness analysis is now commonly used to inform decisions about competing treatment options based on a comparison of relative benefits and costs. However, the longer-term empirical data needed to inform healthcare decisions for PD (such as disease progression, morbidity and mortality, disability in activities of daily living, home care requirements, institutionalization, HR-QOL) are rarely provided by clinical trials or observational studies. Indeed, it is unlikely that data from randomized controlled trials, even those with concurrent collection of health economic data, will be sufficient to satisfy the needs of decision makers who require a synthesis of all the evidence relevant to their specific decision-making context.[6] In the absence of empirical data, modelling methods have been used to estimate the future costs and future consequences of alternative treatment strategies. Where data are not available on longer-term outcomes, decision-analytic models can provide a logical mathematical framework to extrapolate intermediate outcomes (i.e. clinical endpoints) from a range of sources, including clinical trials, to final outcomes relevant to decision makers.[7,8]

The literature on decision-analytic modelling in PD is relatively undeveloped. Two recent reviews, one of decision-analytic models in PD[9] and another of the cost effectiveness of pharmacotherapies in early PD,[10] identified only eight published studies. Both reviews found considerable methodological differences between the published models that impeded any comparison of findings.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

The Use of Decision-Analytic Models in Parkinson's Disease
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.