Parkinson's disease is a widespread neurological disorder that is more common in older individuals. The prevalence of Parkinson's disease increases significantly with age, affecting approximately 1% of those over age 60. Current estimates indicate that approximately 6 million people worldwide have Parkinson's disease. The economic and social burden of Parkinson's disease is also substantial and predicted to increase further as the population ages. Both patients with Parkinson's disease and their caregivers experience reduced quality of life and increased hardship due to the motor and non-motor symptoms of the disease.

1. Epidemiology and burden
Parkinson’s disease
1

2. Prevalence of Parkinson’s disease
2

3. Parkinson’s disease is a widespread public health issue
• PD is recognised as the second-most common
neurodegenerative disorder1
• Approximately 6 million people are diagnosed
with Parkinson’s disease (PD) worldwide2,3
• In Europe, there are an estimated
1.2 million people with PD3
• PD affects 1–2 per 1,000 of the population4,5
• PD affects 1% of the population over the age of
60, but is rare in individuals younger than 50
years4,6
• The prevalence of PD rises with age, and in the
oldest age groups, PD reaches a prevalence of
approximately 4%4,7
3
1. Bertram & Tanzi. J Clin Invest 2005;115(6):1449–1457;
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
Cost per case of specific brain disorders in Europe8
Parkinson’s disease
Affective disorders
40,000
30,000
20,000
10,000
0
Cost per patient (€)
Multiple sclerosis
Tumour
Stroke
Dementia
Psychotic disorder
Epilepsy
Trauma
Addiction
Anxiety disorders
Migraine

4. Prevalence of Parkinson’s disease in the USA
• Prevalence describes the
number of people with a given
condition at a given time (often
expressed per 100,000 people)1
• Incidence rates describe the
number of new cases of a given
condition arising over a given
time, usually per year, often
expressed per 100,000 people1
4
• Estimates vary, but there are
approximately 1 million people in
the USA living with PD2
• The incidence rate in the USA has
been approximated to be 13.4 per
100,0003
• This rate rises rapidly over the age
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

5. Prevalence of Parkinson’s disease in Europe
• A meta-analysisa comparing
studies 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 people1
5
• This meta-analysis identified
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)
aA meta-analysis is a study using data from several other studies
1. von Campenhausen et al. Eur Neuropsychopharmacol 2015;15:473–490
The prevalence of PD is difficult to measure; however, the disease
is more commonly found in older individuals

6. Prevalence of Parkinson’s disease in China
6
1. Zou et al. Eur Rev Med Pharmacol Sci 2014;18(24):3908–3915
29 provinces, China, 1991
Zou et al. 2014 China survey
Three cities, China, 2005
Keelung, Taiwan, 2009
Ilan county, Taiwan, 2001
The prevalence of PD in China
continues to rise after 80
years of age; the overall rates
are similar to other countries
and regions1
55 60 65 70 75 80 85 90 95
Age (years)
5
4
3
1
2
0
Prevalence
(%)
Comparison of age-specific prevalence of PD in
community-based surveys in China (adapted from Zou et al., 20141)

7. Prevalence of Parkinson’s disease by age
• In a meta-analysis of worldwide
data, the prevalence of PD
increased with age, from 41 per
100,000 people in individuals
40–49 years to 1,903 per 100,000
people in individuals ≥801
• Comparing regions of the world,
Asia had a lower prevalence than
other areas at all ages studied1
7
1. Pringsheim et al. Movement Dis 2014;29(13):1583–1590
Prevalence of PD by age and geographic location
(per 100,000 people)1
Location
Age range (years)
50–59 60–69 70–79 80+
South America 228 637 2,180 6,095
Europe/
North America/
Australia
113 540 1,602 2,953
Asia 88 376 646 1,418

8. Prevalence of Parkinson’s disease by sex
• In a meta-analysis of worldwide
data, in the 50–59 age group,
males had a significantly increased
prevalence of PD of 134 per
100,000 people relative to females,
with a prevalence of PD of 41 per
100,000 people (p<0.05)1
8
1. Pringsheim et al. Movement Dis 2014;29(13):1583–1590
Prevalence of PD by sex and geographic location
(per 100,000 people)1
Location Female Male
South America 808 1,267
Europe/
North America/
Australia
1,267 1,535
Asia 306 371
The prevalence of PD was greater
amongst men than women1

9. Predictions of the increase in Parkinson’s disease prevalence
• Based on an analysis of epidemiological
data in Western Europe’s 5 most and the
world’s 10 most populous nations,a it was
estimated that the prevalence of PD in
individuals over 50 years of age would rise
from 4.1 million people in 2005, to 8.7
million people by 20301
• The burden of PD is expected to grow
substantially, and to become increasingly
concentrated outside the Western world1
9
aEurope: 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
The predicted increased prevalence of PD in
individuals over 50 years old1
Year
2005
5
4
3
1
2
0
Number
of
individuals
with
PD
(millions)
2010 2015 2020 2025 2030
China
Europe

10. Risk factors associated with Parkinson’s disease
10
aStrongest 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
The risk of developing PD is a balance of the effect of positive and negative
factors on the genetic predisposition of an individual2
Risk factors1,2
• Age
• Sex
• Genetics
• Pesticide exposure
• Dairy
• Melanoma
• Traumatic brain injury
Protective factors1,2
• Smoking/tobacco use
• Caffeine
• Urate
• Physical activity
• NSAIDsa
• Calcium channel blockers

11. The burden of Parkinson’s disease
11

12. The economic burden of Parkinson’s disease
• In a study estimating the economic
burden of PD in the USA between
1999–2002:1
• Direct costs: $10,349 per patient
• Indirect costs: $25,326 per patient
• Total cost to the US: $23.0 billion per
year
• Outpatient care and drug costs
accounted for a relatively small
proportion of the economic burden1
12
1. Huse et al. Mov Disord 2005;20(11):1449–1454
Breakdown of PD-related costs1
By far the largest share of
the cost (49.4% of the total)
is due to productivity loss1
Productivity loss
49.4%
Uncompensated
care
18.8%
Inpatient care
19.9%
Outpatient
care
7.5%
Prescription
drugs
4.4%

13. The indirect costs of Parkinson’s disease
• Indirect costs are the expenses
incurred from the cessation or
reduction of work productivity as a
result of the morbidity and mortality
associated with a given disease1
• Indirect costs include:1,2
• Work loss
• Worker loss and replacement
• Lost/reduced productivity
• Absenteeism (habitual absence from
work)
13
• In one analysis within the USA, the
indirect costs of PD represented
45% of the total excess costsa
within the first year after diagnosis2
• In several studies analysing the
costs of PD, the indirect costs were
greater than the direct costs3-5
aExcess 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

14. The costs of hospitalisation
0
1,000
2,000
3,000
4,000
5,000
<65 65–74 75–84 >85
Age (years)
National Health System
Social services
Private expenditure
In the English National Health
System, an analysis of hospital
admissions between April 2009
and March 2013 showed:1
• 324,055 PD-related hospital
admissions
• The costs of non-elective
PD-related hospital admissions
totalled £777 million
• These costs were driven largely
by admissions for pneumonia or
for PD itself
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
Direct costs of PD in the UK2,3
Cost
of
PD
per
patient
per
year
(£)
14

15. The increasing economic burden of Parkinson’s disease
0
1,000
2,000
3,000
4,000
0 1 2 3 4
Costs
(€)
Years
Indirect costs
Direct costs
15
• An analysis within the Spanish
health system estimated the costs
of PD during 4 years1
• Direct costs increased by 52% from
year 1–41
• Indirect costs increased by 129%1
1. Martinez-Martín et al. PLoS One 2015;10(12):e0145310
Costs of PD over 4 years
Costs increased with the
progression and the severity
of the disease1

16. The predicted burden of Parkinson’s disease in the future
0
2
4
6
8
10
2010 2020 2030 2040 2050
Medical
cost
of
PD
(in
2010
billion
$)
Year
Self/family Commerical
Medicaid/public Medicare
• In 2010, an estimated 630,000 people in the
United States had clinically-diagnosed PD1
• Population projections suggest that the
number of people diagnosed with PD will
increase to 1.34 million by 20501
• This translates to an increase in medical
costs from an estimated $8 billion in 2010
to >$18 billion in 20501
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
Medical costs of PD over time1
The prevalence of PD in the USA is likely
to double between 2010 and 20401
16

17. 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
17
aIncluding congestive heart failure, stroke, chronic low back pain, arthritis, diabetes, and angina/coronary heart disease
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

18. The burden of non-motor symptoms on the patient
• Neuropsychiatric symptoms, including
depression, anxiety, apathy, fatigue and
psychosis (hallucinations and/or delusions) are
common in patients with PD1
• 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
• Memory complaints
• Sleep disturbance
18
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
Correlation between non-motor symptoms
and quality of life scores
(adapted from Duncan et al., 20142)
There was a significant correlation between the total number of
non-motor symptoms reported and quality of life2
Worsening
score
on
the
PD
Quality
of
Life
Questionnaire
Increasing number of
non-motor symptoms

19. The burden of Parkinson’s disease on caregivers
• Caregivers of patients with PD are
almost always relatives, and are
often elderly1
• Caring for a patient with PD places
a considerable burden on the
caregiver1
• Caregiver burdens include:2
• Health problems
• Modification of habits
• Economic loss
• Deterioration of quality of life
19
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
• Disability
• PD symptoms
• Disease duration
• Higher medical
costs
• Gait impairment
• Use of
antidepressants
• Postural instability
and falls
• Quality of life
• Motor symptoms
• Medical
comorbidities
• Neuropsychiatric
symptoms
(including cognitive
impairment,
psychosis, apathy,
depression, and
impulse control
disorders)3
Patient-related variables that impact on
the caregiver:1

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

21. “
Parkinson’s disease is a disease
with growing prevalence and
negative effects on quality of life
21
Boland & Stacy. Am J Manag Care 2012;18(7 Suppl):S168–175