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Cost-efficacy of an adapted physical activity program in Parkinson’s disease

Cost-efficacy of an adapted physical activity program in Parkinson’s disease

A clinical trial evaluating the benefit of the quality of life and cost-effectiveness of an additional program of adapted physical activities (APA) with usual care for patients with Parkinson’s disease who have a high risk for falls.

A randomized controlled trial of English Fletcher and colleagues, published in the journal BioMed Central in 2012, compares the effectiveness after five months of a tailored physical activity program (APA) compared to usual care on quality of life and cost-effectiveness in patients with Parkinson’s disease. An adapted physical activity program from 10 weeks to one session per week supervised and unsupervised two does not reduce health costs (drugs, primary and secondary health care services) and does not improve the quality life compared to routine care. By cons, a statistical projection leads us to think that an adapted physical activity program had a cost-effectiveness ratio compared with usual care.


The Study Rationale

Parkinson’s disease is a neurodegenerative disease that primarily affects the elderly. Prevalence is estimated at 1% in people over 60 years. The disease is very expensive, both for patients and their families, and for the health care system and welfare. 60% is spent on hospitalizations and drug therapies. Annual spending in England are superior to 1.4 billion pounds in the light of health care, informal care, loss of productivity and cost increases with the progression of the disease.

In addition to the disease, it is noteworthy that 65% of patients are injured. They are victims of falls that reduce their physical autonomy. 33% 65% will suffer a subsequent fracture from a fall. 75% of falls result in higher care and additional social costs. Any fall even without damage, causes a fear of falling reducing the activities of daily life and affects health-related quality of life.

A targeted program of adapted physical activities would reduce the number and severity of falls among these vulnerable people. It may be cost-effective and beneficial for the quality of life of these people.

A targeted program of adapted physical activities reduce spending on care to a consecutive drop and improve the quality of life of patients affected by Parkinson’s disease.

The Question

An adapted physical activity program enables it to prevent the risk of falls in patients with Parkinson’s disease? The cost-effectiveness and quality of life-adjusted life years (QALYs) are they improved?

The Method

The randomized controlled trial of Fletcher and his collaborators published in 2012 evaluates a program adapted physical activities on the quality of life related to health and cost-effectiveness in 93 patients with Parkinson’s disease. Participants had a mean age of 71 years. They had fallen at least twice in the year preceding the study. They were randomly assigned to the group receiving the adapted physical activity program or in the control group continuing usual care.

The measures concerned the health-related quality of life (with EQ-5D) and cost effectiveness (based on the principle of QALY, the English “quality-ajusted life year”, corresponding to the amount and quality of life years gained through an intervention or treatment). Evaluations are performed before the start of surgery and at 20 weeks follow-up.

The Non-Pharmacological Intervention (NPI) assessed

The supervised program of adapted physical activities lasted 10 weeks, with encouragement to continue. It included a session supervised group once a week (maximum of 6 participants) in a community facility. Two sessions per week were done at home based on individual recommendations. The exercises were aimed at improving endurance, muscle strength and postural balance. The sessions were designed and conducted by professionals trained national health service to monitor elderly people with Parkinson’s disease.

Main Results

The results show, the end of surgery an average cost of 76 pounds per participant in the group benefiting from physical activity. No differences on social and health care services was observed between the two groups. The results show no added value of non-drug intervention in terms of QALYs to 20 weeks. A statistical projection indicates that there would be an 80% chance that physical activity is a more cost-effective than usual care for Parkinson’s disease, for which the company is prepared to pay around £ 20,000 per QALY.

An adapted physical activity program from 10 weeks to one session per week supervised and unsupervised two does not reduce spending on health and does not improve the quality of life compared to a control group for a follow-up post -intervention 2.5 months. However, the results seem promising over a longer period.


What it means for Patients

An adapted physical activity program from 10 weeks to one session per week supervised and unsupervised two does not reduce health costs (drugs, primary and secondary health care services) and does not improve the quality life compared to routine care. By cons, a statistical projection leads us to think that an adapted physical activity program had a cost-effectiveness ratio compared with usual care.

What it means for Healthcare Professionals

A 10-week adapted physical activity program based on endurance, muscle strength and balance at the rate of one session per week supervised and unsupervised two does not reduce health care costs and does not improve quality of life compared to a control group. However, a statistical projection suggests that more than 80% chance that the intervention in adapted physical activities or a more profitable strategy in terms of cost to society compared with usual care.

What it means for Researchers

A statistical projection suggests that more than 80% chance that the intervention in adapted physical activities or a more profitable strategy in terms of cost to society compared with usual care. Future research will need to demonstrate over a longer period of 2 months and followed by half.

What it means for Policymakers

The establishment of an adapted physical activity program (APA) is cheap (£ 76 per person). This non-drug intervention is probably a profitable year. But this study lack of power to demonstrate a difference in terms of costs and QALYs between the two groups. Studies on a larger scale and over a longer period of 2 ½ months to come should confirm these results.


The Reference

Fletcher E, Goodwin VA, Richards SH, Campbell JL, Taylor RS (2012). An exercise intervention to prevent falls in Parkinson’s: an economic evaluation. BioMed Central, 12, 1-9.


Related articles on Blog en Sante ©

Same topic

Same population

Same non-pharmacological intervention


To reference this Blog en Sante © article

Ninot G (2015). Cost-efficacy of a physical activity program in Parkinson’s disease. Blog en Sante, A72.

© Copyright 2015 Gregory Ninot. All rights reserved.

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