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Higher levels of Apomorphine and Rotigotine prescribing reduce overall secondary healthcare costs in Parkinson’s disease

Author: Mike Stedman & Dr Adrian Heald [with educational grant from Britannia]

Published: Article in International Journal of Clinical Practice 70(11):907-915 · November 2016

Background Parkinson’s disease (PD) affects around 100,000 people in England. A number of non-oral therapies can improve both the quality of life and reduce patient needs for health and social care. However, these can be relatively expensive at £2,000–£10,000 per year per patient. Our aim was to examine how prescribing of these agents relates to secondary care costs. Methods Using practice level primary care prescribing data and hospital episode statistical (HES) data in England, we investigated the relation between GP prescriptions of Apomorphine injections/Rotigotine patches and the secondary care costs accrued for their diagnosed PD patients for 2011 to 2014. The median age of the PD patients was 78 years. Results In the period 2011 to 2014, 58% of the average annual £437 million secondary care costs for PD patients came from non-elective admissions. 80% of this came from seven Healthcare Resource Group Chapters linked to PD comorbidities. Compared to practices not using non-oral therapies, practices prescribing Apomorphine saved £897 per year per patient of secondary care costs to offset the average additional prescribing cost of £475 per overall patient per year. For Rotigotine, saving was £718 per year per patient of secondary care costs offsetting £137 prescribing cost. Practices in the highest quartile of non-oral prescribing were using non-oral agents in up to 28% of their PD patients. Conclusions Those practices which used more non-oral therapies appear to incur less secondary care costs. 70% of the advanced PD patients are not being given access to non-oral treatment. This is a challenge for all physicians looking after the older patient.

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