Pharmacotherapy in the management of early Parkinson's disease: cost-effectiveness and patient acceptability.

In the absence of a cure, the primary goals in managing Parkinson's disease (PD) are to preserve functionality and health-related quality of life (HRQoL). Current therapeutic strategies for PD include symptomatic treatment and are primarily focused on replacing dopamine in the brain. Dopamine agonists can be used as an alternative initial levodopa therapy, to delay the onset of motor complications, but at the expense of more dopaminergic adverse effects; poorer control of motor symptoms; and increased cost. In PD, treatment effects and costs accumulate over time; hence the choice of time horizon in cost-effectiveness analysis can be particularly important. Pharmaceutical expenditures have grown rapidly in recent decades and now total nearly 10% of all health care costs. The main approach to treat PD at the present time is to advance knowledge of the efficacy, to reduce long-term complications associated with treatment, and to improve patient HRQoL and society burden. The implementation of cost-effectiveness studies, including the societal perspective, should be considered as an outcome of new therapy strategies, which would be helpful to health care decision makers.