Research Article| Volume 319, ISSUE 1-2, P24-31, August 15, 2012

Treatment patterns and associated costs with Parkinson's disease levodopa induced dyskinesia



      This study examined the treatment patterns, direct healthcare costs and predictors of treatment costs associated with levodopa-induced dyskinesia (LID) in Parkinson's disease (PD).


      This retrospective cohort study followed PD patients for 1‐year pre- and post-onset of LID, using a large US health insurance claims database from January 1, 2004 to December 31, 2008. Patients with LID were matched to patients without LID based on propensity scores to control for potential selection bias. Descriptive statistics and bootstrap techniques were employed to assess patient demographic and clinical characteristics and costs incurred. Factors influencing treatment costs were analyzed using a generalized linear model with log-link function and gamma distribution. Costs were adjusted to 2009 prices.


      After patients developed LID, their total treatment costs were increased from $18,645 during the 12 months preceding LID onset to $26,439 for the 12-month period subsequent to LID onset (incremental costs of $7795: P<0.001). PD-related costs increased from $3917 to $8110 (incremental costs of $4194: p<0.001) LID events, medical resource utilization, higher levodopa dosage, and use of alternative PD medications were associated with increases in total treatment costs. Few changes in medication treatment patterns were noted following the initial LID, with only slight increases in levodopa dosage and few additions of alternative agents.


      In the United States, PD patients with LID impose a significant economic burden when compared to patients without LID. Currently available, treatment strategies for dyskinesia should be used more frequently in PD management, and new treatment strategies should be considered as they may lower healthcare costs.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dorsey E.
        • Constantinescu R.
        • Thompson J.
        Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030.
        Neurology. 2007; 68: 384-386
        • Huse D.
        • Schulman K.
        • Orsini L.
        Burden of illness in Parkinson disease.
        Mov Disord. 2005; 20: 1449-1454
        • Dodel R.C.
        • Singer M.
        • Kohne-Volland R.
        • Szucs T.
        • Rathay B.
        • Scholz E.
        • et al.
        The economic impact of Parkinson's disease: an estimation based on a 3 month prospective analysis.
        Pharmacoeconomics. 1998; 14: 299-312
        • Ahlskog J.E.
        • Muenter M.D.
        Frequency of levodopa-related dyskinesisa and motor fluctuations as estimated from the cumulative literature.
        Mov Disord. 2001; 16: 448-458
        • National Institute for Health and Clinical Excellence
        Parkinson's disease: diagnosis and management in primary and secondary care (NICE clinical guideline 35).
        National Health Service, London, UK2006
        • Dodel R.C.
        • Berger K.
        • Oertel W.H.
        Health-related quality of life and healthcare utilisation in patients with Parkinson's disease: impact of motor fluctuations and dyskinesias.
        Pharmacoeconomics. 2001; 19: 1013-1038
        • Chapuis S.
        • Ouchchane L.
        • Metz O.
        • Gerbaud L.
        • Durif F.
        Impact of the motor complications of Parkinson's disease on the quality of life.
        Mov Disord. 2005; 20: 224-230
        • Maurel F.
        • Lilliu H.
        • Le Pen C.
        Social and economic cost of l-Dopa-induced dyskinesias in patients with Parkinson's disease.
        Rev Neurol (Paris). 2001; 157: 507-514
        • Fahn S.
        Medical treatment of Parkinson's disease.
        J Neurol. 1998; 245: P15-P24
        • Gottwald M.D.
        • Aminoff M.J.
        Therapies for dopaminergic-induced dyskinesias in Parkinson disease.
        Ann Neurol. 2011; 69: 919-927
        • Lang A.
        • Houeto J.
        • Krack P.
        Deep brain stimulation: preoperative issues.
        Mov Disord. 2006; 21: S171-S196
        • Pahwa R.
        • Factor S.A.
        • Lyons K.E.
        • Ondo W.G.
        Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
        Neurology. 2006; 66: 983-995
        • Pechevis M.
        • Clarke C.E.
        • Vieregge P.
        • Khoshnood B.
        Effects of dyskinesias in Parkinson's disease on quality of life and health-related costs: a prospective European study.
        Eur J Neurol. 2005; 12: 956-963
        • Findley L.
        • Aujla M.
        • Bain PG
        • Baker M.
        • Beech C.
        • Bowman C.
        • et al.
        Direct economic impact of Parkinson's disease: a research survey in the United Kingdom.
        Mov Disord. 2003; 18: 1139-1145
        • Whetten-Goldstein K.
        • Sloan F.
        • Kulas E.
        • Custon T.
        • Schenkman M.
        The burden of Parkinson's disease on society, family, and the individual.
        J Am Geriatr Soc. 1997; 45: 844-849
        • O'Brien J.A.
        • Ward A.
        • Michels S.L.
        • Tzivelekis S.
        • Brandt N.J.
        Economic burden associated with Parkinson disease.
        Drug Benefit Trends. 2009; 21: 179-190
        • Dodel R.
        • Reese J.-P.
        • Balzer M.
        • Oertel W.H.
        The economic burden of Parkinson's disease.
        Eur Neuro Rev. 2008; 3: 11-14
        • Adamson D.M.
        • Chang S.
        • Hansen L.G.
        Health research data for the real world: The MarketScan Databases (white paper).
        • Ciranni M.A.
        • Kearney T.E.
        • Olson K.R.
        Comparing acute toxicity of first- and second-generation antipsychotic drugs: a 10-year, retrospective cohort study.
        J Clin Psychiatry. 2009; 70: 122-129
        • Kenney C.
        • Hunter C.
        • Davidson A.
        • Jankovic J.
        Metoclopramide, an increasingly recognized cause of tardive dyskinesia.
        J Clin Pharmacol. 2008; 48: 379-384
        • Parkinson Study Group
        Entacapone improves motor fluctuations in levodopa-treated Parkinson's disease patients. Parkinson Study Group.
        Ann Neurol. 1997; 42: 747-755
        • Woerner M.G.
        • Alvir J.M.
        • Saltz B.L.
        • Lieberman J.A.
        • Kane J.M.
        Prospective study of tardive dyskinesia in the elderly: rates and risk factors.
        Am J Psychiatry. 1998; 155: 1521-1528
        • Clinical Policy Bulletin (Deep Brain Stimulation)
        (Accessed Oct 08, 2011, at)
        • Clinical Policy Bulletin (Thalamotomy)
        (Accessed Oct 14, 2011, at)
      1. Stereotactic radiofrequency pallidotomy. Medical policy.
        (Accessed Oct 10, 2011, at)
        • Medical Policy (Deep Brain Stimulation)
        (Accessed Oct 8, 2011, at)
        • Deep Brain Stimulation
        (Accessed Oct 8, 2011, at)
        • Blanford L.
        • Dans P.E.
        • Ober J.D.
        • Wheelock C.
        Analyzing variations in medication compliance related to individual drug, drug class, and prescribing physician.
        J Manag Care Pharm. 1999; 5: 47-51
        • Sikka R.
        • Xia F.
        • Aubert R.E.
        Estimating medication persistency using administrative claims data.
        Am J Manag Care. 2005; 11: 449-457
        • Sokol M.C.
        • McGuigan K.A.
        • Verbrugge R.R.
        • Epstein R.S.
        Impact of medication adherence on hospitalization risk and healthcare cost.
        Med Care. 2005; 43: 521-530
        • Gu X.S.
        • Rosenbaum P.R.
        Comparison of multivariate matching methods: structures, distances, and algorithms.
        J Comput Graphical Stat. 1993; 2: 405-420
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Hosmer D.W.
        • Lemeshow S.
        Applied logistic regression.
        2nd ed. John Wiley & Sons, New York, NY2000
        • Agresti A.
        Categorical data analysis.
        2nd ed. John Wiley & Sons, New York, NY2002
        • Desgagne A.
        • Castilloux A.-M.
        • Angers J.-F.
        • LeLorier J.
        The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data.
        Pharmacoeconomics. 1998; 13: 487-497
        • Kumar N.
        • Van Gerpen J.A.
        • Bower J.H.
        Levodopa-dyskinesia Incidence by age of Parkinson's disease onset.
        Mov Disord. 2005; 20: 342-366
        • Schrag A.
        • Schott J.M.
        Epidemiological, clinical, and gentic characteristics of early-onset parkinsonism.
        Lancet Neurol. 2006; 5: 355-363
        • Fahn S.
        • Oakes D.
        • Shoulson I.
        • Kieburtz K.
        • Rudolph A.
        • Lang A.
        • et al.
        Levodopa and the progression of Parkinson's disease.
        N Engl J Med. 2004; 351: 2498-2508
        • Hauser R.A.
        • McDermott M.P.
        • Messing S.
        Factors associated with the development of motor fluctuations and dyskinesias in Parkinson disease.
        Arch Neurol. 2006; 63: 1756-1760
        • Metman L.V.
        • Konitsiotis S.
        • Chase T.N.
        Pathophysiology of motor response complications in parkinson's disease: hypotheses on the why, where, and what.
        Mov Disord. 2000; 15: 3-8
        • Stacy M.
        • Galbreath A.
        Optimizing long-term therapy for Parkinson disease: options for treatment-associated dyskinesia.
        Clin Neuropharmacol. 2008; 31: 120-125
        • Zesiewicz T.A.
        • Sullivan K.L.
        • Hauser R.A.
        Levodopa-induced dyskinesia in Parkinson's disease: epidemiology, etiology, and treatment.
        Curr Neurol Neurosci Rep. 2007; 7: 302-310
        • Fahn S.
        How do you treat motor complications in Parkinson's disease: medicine, surgery, or both?.
        Ann Neurol. 2008; 64: S56-S64
        • Muller T.
        • Russ H.
        • Hock K.
        Prevalence and treatment strategies of dyskinesia in patients with Parkinson's disease.
        J Neural Transm. 2007; 114: 1023-1026
        • Van Gerpen J.A.
        • Kumar N.
        • Bower J.H.
        • Weigand S.
        • Ahlskog J.E.
        Levodopa-associated dyskinesia risk among Parkinson disease patients in Olmstend Count, Minnesota, 1976–1990.
        Arch Neurol. 2006; 63: 205-209
        • Verhagen Metman L.
        • Del Dotto P.
        • van den Munckhof P.
        • Fang J.
        • Mouradian M.M.
        • Chase T.N.
        Amantadine as treatment for dyskinesias and motor fluctuations in Parkinson's disease.
        Neurology. 1998; 50: 1323-1326
        • Thanvi B.
        • Lo N.
        • Robinson T.
        Levodopa-induced dyskinesia in Parkinson's disease: clinical features, pathogenesis, prevention and treatment.
        Postgrad Med J. 2007; 83: 384-388
        • Charles D.P.
        • Padaliya B.B.
        • Newman W.J.
        • Gill C.E.
        • Covington C.D.
        • Fang J.Y.
        • et al.
        Deep brain stimulation of the subthalamic nucleus reduces antiparkinsonian medication costs.
        Parkinsonism Relat Disord. 2004; 10: 475-479
        • Kumar R.
        • Lozano A.M.
        • Kim Y.J.
        • Hutchison W.D.
        • Sime E.
        • Halket E.
        • et al.
        Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease.
        Neurology. 1998; 51: 850-855
        • Limousin P.
        • Krack P.
        • Pollak P.
        • Benazzouz A.
        • Ardouin C.
        • Hoffmann D.
        • et al.
        Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease.
        N Engl J Med. 1998; 339: 1105-1111
        • Brooks D.J.
        • Sagar H.
        Entacapone is beneficial in both fluctuating and non-fluctuating patients with Parkinson's disease: a randomised, placebo controlled, double blind, six month study.
        J Neurol Neurosurg Psychiatry. 2003; 74: 1071-1079