| 1. |
- Norlin, Jenny M., et al.
(författare)
-
Swedish guidelines for device-aided therapies in Parkinson's disease —Economic evaluation and implementation
- 2021
-
Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 144:2, s. 170-178
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The National Board of Health and Welfare in Sweden published the national guidelines for Parkinson's Disease 2016. The aim of this study was to summarize this evidence review and development of the guidelines, focusing on the economic evaluation of device-aided therapies (deep brain stimulation, pump-based infusion of levodopa-carbidopa intestinal gel or apomorphine) for Parkinson's disease, and the rate of implementation after 3 years in Sweden. Material and methods: The evidence review underlying the guidelines—including systematic literature searches of clinical and economic evidence, model-based economic evaluation, and formal analysis and guideline development—was examined, condensed, and translated. The impact of the guidelines was assessed with treatment use statistics from 2009 to 2019. Results: All device-aided therapies were assigned high priority. Based on a relatively low proportion of device-aided therapies (30%) in Parkinson's disease, a 5-year increase of 500 patients was recommended. This was estimated to reduce total costs by SEK 14 million (€1.7 million). Follow-up data found an increase of 217 patients between 2017 and 2019, following the same trend as before the guidelines. Conclusion: Three years after the guidelines were published, the use of device-aided therapies has increased in Sweden, albeit not in pace with recommendations. One reason for slow implementation may be poor incentivization related to budget silos in which the costs for device-aided therapies are borne by the regions but the cost offsets (eg, reduced need for home care) are reaped by local stakeholders.
|
|
| 2. |
- Pålhagen, Sven E., et al.
(författare)
-
Levodopa-carbidopa intestinal gel (LCIG) treatment in routine care of patients with advanced Parkinsons disease: An open-label prospective observational study of effectiveness, tolerability and healthcare costs
- 2016
-
Ingår i: Parkinsonism & Related Disorders. - : ELSEVIER SCI LTD. - 1353-8020 .- 1873-5126. ; 29, s. 17-23
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) can effectively manage motor and non-motor complications in advanced Parkinsons disease (PD). Healthcare costs, quality of life (QoL), effectiveness, and tolerability were assessed in routine care treatment with LCIG. Methods: The seventy-seven patients enrolled in this prospective, open-label, 3-year study in routine medical care were LCIG-naive (N = 37), or had previous LCIG treatment for amp;lt;2 (N = 22), or amp;gt;= 2 (N = 18) years. Healthcare costs were collected monthly. PD symptoms and QoL were assessed with the Unified Parkinsons Disease Rating Scale (UPDRS), 39-item Parkinsons Disease Questionnaire (PDQ-39), and EuroQoL 5-Dimension Visual Analog Scale (EQ-5D VAS); LCIG dose, safety, and tolerability were monitored. Results: Mean monthly costs per patient ( 8226 5952) were similar across cohorts, remained steady during 3-year follow-up, and increased with PD severity and QoL impairment. In LCIG-naive patients, significant improvements compared to baseline were observed on the UPDRS total score and PDQ-39 summary index score through 18 months (n = 24; UPDRS, p = 0.033; PDQ-39, p = 0.049). Symptom control was maintained during 3-year follow-up in LCIG-experienced cohorts. Small changes in mean daily LCIG dose were observed. Adverse events were common and generally related to the device, procedure, levodopa, or laboratory evaluations. Conclusions: Costs in LCIG-treated patients were stable over 3 years. LCIG treatment led to significant improvements in motor function and QoL over 18 months in LCIG-naive patients and no worsening was observed in LCIG-experienced patients over 3 years despite natural PD progression over time. The longterm safety was consistent with the established LCIG profile. (C) 2016 AbbVie Inc. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
|
|
| 3. |
- Pålhagen, Sven E
(författare)
-
Parkinson’s disease and depression : clinical and neurobiological studies
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Parkinson´s disease (PD) is a progressive degenerative movement disorder. PD patients also suffer from several non-motor symptoms including autonomic disturbances, cognitive decline and neuropsychiatric conditions. In this thesis, studies were conducted to increase our knowledge on the pathophysiology and treatment of major depression (MD) in patients with PD. Clinical rating studies on the prevalence as well as neurological and psychiatric symptoms in patients with PD and MD, solely PD and solely MD were performed. The therapeutic responsivity towards the commonly used antidepressant, citalopram, in PD + MD and MD patients was investigated. In parallel with these clinical studies, imaging studies were made and cerebrospinal fluid (CSF) collected. These studies showed that MD in PD is not as frequent in Sweden as has been previously reported. PD patients with a comorbid MD had more severe neurological symptoms than PD patients without depression, indicating an advanced and widespread neurodegenerative process. Treatment with citalopram in PD patients with MD on stable dopaminergic therapy reduced the depressive symptoms as effective as in MD patients without PD. The antidepressive effect occurred earlier in the PD patients. The PD symptoms of hypokinesia and rigidity as well as involuntary movements were reduced during treatment with citalopram. On the other hand, tremor increased during this treatment, possibly a result of increased serotonergic neurotransmission. Imaging studies showed that regional cerebral blood flow differs between PD patients with and without MD, as well as between MD patients with and without PD, both at baseline and regarding the response to treatment with citalopram. However, treatment with citalopram normalizes the mood-related abnormal rCBF pattern in both only MD and PD + MD patients, although in different ways. Biochemical studies of CSF showed that PD patients with MD have significantly lower baseline levels of MHPG, corticosterone and IL-6 when compared to solely MD patients. Moreover, in response to citalopram treatment, patients with solely MD exhibited an expected decrease in 5-HIAA and MHPG levels which was not found in PD patients with MD. Moreover, the levels of BDNF and IL-6 were lower in PD + MD patients compared to solely MD patients after treatment with citalopram in both groups. Taken together, these data suggest that MD in PD could be an indication of a more advanced and widespread neurodegenerative process. These data have also provided imaging and biochemicalevidence that there is a different antidepressant response towards SSRI medication in PD patients with MD compared to MD patients without PD, indicating diverse underlying pathophysiological mechanisms.
|
|
| 4. |
- Pålhagen, Sven, et al.
(författare)
-
Rufinamide : A double-blind, placebo-controlled proof of principle trial in patients with epilepsy
- 2001
-
Ingår i: Epilepsy Research. - 0920-1211 .- 1872-6844. ; 43:2, s. 115-124
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: This was the first proof of principle clinical trial assessing the efficacy and safety of rufinamide as adjunctive therapy in epileptic patients. The pharmacokinetic (PK) profile of rufinamide was also determined. Methods: Fifty patients with diagnoses of partial or primary generalized tonic-clonic seizures were enrolled in this 28-day double-blind, placebo-controlled, weekly rising dose (400-1600 mg/day) trial. PK profiles were obtained after administration of single-dose rufinamide prior to and after the Double-blind phase. Results: In the evaluable patient population, seizure frequency decreased by 41% in the rufinamide group and increased by 52% in the placebo group (P = 0.040). Thirty-nine percent (39%) of rufinamide-treated and 16% of placebo-treated patients experienced reduction in seizure frequency of at least 50% relative to baseline (P = 0.096). Safety: Treatment-emergent adverse events (AEs) consisted mainly of neurologic signs and symptoms commonly associated with antiepileptic drugs (AEDs). Pharmacokinetics: At steady state, rufinamide reached a peak plasma concentration with a mean time (Tmax) of 3.4 h and a mean half-life (t1/2) of 7.3 h. No autoinduction of rufinamide metabolism occurred. Rufinamide did not influence the plasma concentration of carbamazepine, phenytoin or valproate when added to these single AED regimens. Conclusion: Rufinamide has been shown, in this proof of principle trial, to be safe and effective in reducing seizure frequency in epileptic patients with no relevant influence on the metabolism of other AEDs. © 2001 Elsevier Science B.V.
|
|
| 5. |
- Timpka, Jonathan, et al.
(författare)
-
Workforce unavailability in Parkinson's disease
- 2017
-
Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 135:3, s. 332-338
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Individuals with Parkinson's disease (PD) become unavailable in the workforce earlier than comparable members of the general population. This may result in significant social insurance expenses, but as workforce participation can be a source for social interaction and a vital part of the personal identity, there are likely to be personal implications extending far beyond the economic aspects. This study aimed to identify aspects that may contribute to workforce unavailability in people with PD. Materials & methods: This was a cross-sectional registry study using data from the Swedish national quality registry for PD and included persons with PD in Skåne County, Sweden who were younger than 65 years. Variables were selected from the registry based on earlier studies and clinical experience and were tested for association with unavailability in the workforce: first in a series of simple regression analyses and then in a multiple logistic regression analysis. Results: A total of 99 persons with PD-of whom 59 were available and 40 were unavailable in the workforce-were included in the study. Age (OR per year: 1.47, 95% CI: 1.18-1.85; P <0.01) and anxiety (OR: 6.81, 95% CI: 1.20-38.67; P = 0.03) were significant contributing factors for unavailability in the workforce. Conclusions: Based on the findings in this exploratory study, anxiety-a potentially modifiable factor-and age may be contributing factors for workforce unavailability in PD. However, prospective studies are warranted to confirm the findings and the causation of the association between anxiety and workforce unavailability needs to be clarified.
|
|
