https://orcid.org/0000-0003-2815-0505
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Abstract
Aims
The Parkinson’s KinetiGraph (PKG) is a wrist-worn movement recording system that collates continuous, objective, data during daily activities in people with Parkinson’s disease (PD) providing a report for clinicians. This study explores the cost-effectiveness of adding the PKG to routine PD assessments.
Methods
A de novo Markov model of three health states: uncontrolled, controlled and death compared PKG plus routine assessment by a Movement Disease Specialist (MDS) versus routine assessment. Uncontrolled and controlled states were based on the Movement Disorder Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) II and III scores. The transition between health states was dependent on improvement in MDS-UPDRS II and III, and transition to death state on all cause-mortality and PD-specific relative mortality risk. Markov cycle length was yearly beyond year 1 and lifetime horizon 22 years.
Limitations
PKG evidence incorporated in this analysis is based on findings from one clinical trial. Health state utilities were mapped and the probability of patients progressing from uncontrolled to controlled health state at the second visit and beyond was derived from a bootstrap method which assumed a normal distribution for MDS-UPDRS.
Results
The addition of the PKG to usual PD assessments is a cost-effective intervention. PKG plus routine assessment is associated with lower total costs compared to routine assessment (£141,950 versus £159,312) and improved quality-adjusted life years (7.88 versus 7.61), resulting in an incremental cost-effectiveness ratio of −£64,978.99 and a net monetary benefit of £22,706.37 using a £20,000 threshold. Results were robust across sensitivity and scenario analyses.
Conclusions
Management of PD involves monitoring and evaluation of symptoms to assess disease progression and ensure appropriate treatment choices. Adding the PKG to clinical assessment in routine care allows for improved and objective identification of PD motor symptoms which can be used in clinical decision making to improve patient outcomes.
PLAIN LANGUAGE SUMMARY
Hospital doctors caring for people with Parkinson's disease (PwP) regularly monitor and assess their patients’ symptoms, relying on patient recall and patient-completed diaries to find out about current symptoms, which can be unreliable. The Parkinson's KinetiGraph (PKG) is a wrist-worn device that collects continuous information on movement in PwP. A report is then provided to the patient's Consultant helping them to understand the PwP's symptoms and make decisions about changing medication to improve symptom control.
An economic model compared asking patients to wear a PKG device for 6 days before their check-up appointment with their Consultant with usual check-up without the PKG. Information from a clinical trial exploring the use of PKG provided data on Movement Disorder Society – Unified Parkinson's Disease Rating Scale (MDS-UPDRS) II and III scores, which were used in the model to predict improvements in quality of life and whether PwP had controlled or uncontrolled disease.
The model showed that addition of PKG to usual check-ups is a cost-effective approach. Use of the PKG reduced costs (£141,950 versus £159,312 for usual check-ups) and had a positive impact on quality and quantity of life as measured by quality adjusted life years (7.88 versus 7.61).
This study shows that adding the PKG to routine check-ups allows Consultants to accurately assess movement (or motor) symptoms in PwP, which can then be used to ensure optimal mediation choice and improve patient outcomes.
Transparency
Declaration of funding
The study was funded by Global Kinetics Pty Ltd.
Declaration of financial/other relationships
KRC received honoraria and grants from 4 D Pharma, AbbVie, Acadia, Bial Pharma, Boeringer Ingelheim, Britannia, Cynapsus, EU Horizon 2020, GKC, Kyowa Kirin, Lobsor, Medtronic, NIHR, Novartis, Parkinson’s Foundation, Parkinson's UK, Profile Pharma, Roche, Scion, SK Pharma, Stada, Synovion, Therevance, UCB Pharma, Wellcome Trust and Zambon.
AH received honoraria and grants from Bial Pharma, GE Healthcare, Lundbeck, Parkinson’s UK, Syneos Health, Teva UK and UCB Pharma.
FO and JB are employees of JB Medical who were funded by Global Kinetics Pty Ltd to carry out this work and provide medical writing support. JB Medical is a consultancy which works with pharmaceutical and device companies to support market access.
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
FO and JB were responsible for the conception and design of this work. All authors reviewed the manuscript for intellectual content and their comments were incorporated. All authors agree to be accountable for all aspects of this work.
Acknowledgements
We acknowledge the support of Sohaila Rahman of JB Medical Ltd, who provided medical writing expertise funded by Global Kinetics Pty Ltd.