Longitudinal study of the socioeconomic burden of Parkinson's disease in Germany.

OBJECTIVE: To determine the health economic burden on patients with Parkinson's disease (PD) in Germany over a 12-month observation period and provide a comprehensive analysis of cost-driving factors. METHODS AND PATIENTS: Patients with PD (n = 145) were recruited from two clinical departments, two office-based neurologists and 12 GPs. Clinical evaluations were performed at baseline, 3, 6 and 12 months. Disease severity was measured using the Unified Parkinson's Disease Rating Scale (UPDRS). Cost data were assessed based on a patient diary and via personal structured interviews at the respective time-points. Costs were calculated from the societal perspective (2009 euro). Cost-driving factors were identified by multivariate regression analysis. RESULTS: Mean annual costs totalled euro20 095 per patient. Amongst direct costs, the highest expenditures (euro13 158) were for drugs (euro3526) and inpatient care including nursing homes (euro3789). Indirect costs accounted for 34.5% (euro6937) of total costs. Costs of home care provided by family accounted for 20% of direct costs. Cost-driving factors were identified for total costs (UPDRS, fluctuations, dyskinesia and younger age), direct costs (UPDRS, fluctuations), patient expenditures (UPDRS, depression) and drug costs (younger age). CONCLUSION: Parkinson's disease has a chronic course with growing disability and considerable socioeconomic burden. Disease progression leads to an increasing number of patients who require costly institutionalized care. Home care is a major factor influencing patients' families. Healthcare programmes aimed at reducing the burden of PD on society and individuals should consider cost-driving factors of PD.

A replication to increase happiness indices among some people with profound multiple disabilities.

A replication of Green and Reid was made for four people with profound multiple disabilities by systematically increasing their happiness indices in a Fun Time activity during which their preferred stimuli were provided. In ABAB reversal designs, 3 of the 4 participants replicated the demonstration of the happiness indices, while the fourth individual showed reduced unhappiness indices when his preferred stimulation was presented. These effects were obtained despite the selection of preferred stimuli without formal assessment procedures and the use of brief training procedures for staff providing the stimulation. A subgroup of three individuals with profound multiple disabilities and minimal (almost no) movement failed to show any indices of happiness or unhappiness with this procedure. Uses for happiness indices were discussed. Alternative programming was suggested for individuals who failed to show any indices of happiness.