Objective: To understand the economic burden of the cost of Parkinson’s Disease (PD) medications for outpatients receiving care at Shree Krishna Hospital (SKH)  in Karamsad, Gujarat, India. The analysis of the cost of medications for PD has not previously been studied in Gujarat.

Background: Patients in developing countries such as India have difficulty affording medications or non-pharmacological interventions for management of PD. The annual gross national income (GNI) in India was US $1800 in 2017 (1) and only 3% of the Indian population has medical insurance (2). A prior study noted that patients spent nearly 16-42% of the average GNI to buy medications for PD, which is unaffordable for many patients (2).

Method: A retrospective chart review of PD patients who came to the Movement Disorders clinic of SKH between January 1st, 2017 – July 31st, 2018 was completed. Records were reviewed for severity and duration of disease as well as prescribed medications. The cost of medications was investigated using the hospital pharmacy records. The cost of testing, physiotherapy, rehabilitation, travel to and from appointments, and consultation charges was not recorded.

Results: Charts were reviewed of 81 patients with PD (men, 57 [70%]; women, 24 [30%]). The average age of patients was 68 (SD: 8.14). Sample mean duration of disease was 3.3 years (SD: 3.3) and the average Hoehn & Yahr stage was 2.4.  Almost all patients (96%) were taking carbidopa/levodopa. The average daily pill burden of all medications (dopaminergics and non-dopaminergics) was 9.3 (SD: 3.7). The mean yearly cost of PD’s movement related dopaminergic medications was 8,733 rupees [USD $123] (SD: 6,764), and the mean yearly cost of only carbidopa/levodopa was 3,451 rupees [USD $49] (SD: 2,086).

Conclusion: PD imposes a high cost due to its chronic nature and necessitates multiple medications for symptomatic management. In the US, where GNI was $58,270 in 2017 (3), the average yearly cost of medical care for PD is $22,800 per patient (4).  In Gujarat, India, patients diagnosed with PD spent 6.8% of per capita GNI on medications for treatment of PD. If the cost of medications can be subsidized, then affordable treatment can be provided to a larger number of people living in rural Gujarat. Transparency about the cost of PD medications can help to advocate for policy change, increase compliance and improve quality of life.

References: 1. GNI per capita, Atlas method (current US$). (n.d.). Retrieved from https://data.worldbank.org/indicator/NY.GNP.PCAP.CD?end=2017&locations=IN&start=1997 2. Ragothaman M, Govindappa S, Rattihalli R, Subbakrishna D, Muthane U. Direct Costs of Managing Parkinson’s Disease in India: Concerns in a Developing Country. Freshwater Biology, Wiley/Blackwell (10.1111), 27 July 2006 3. GNI per capita, Atlas method (current US$). (n.d.). Retrieved from https://data.worldbank.org/indicator/NY.GNP.PCAP.CD?end=2017&locations=US&start=1997 4. Kowal, S. L., Dall, T. M., Chakrabarti, R., Storm, M. V., & Jain, A. (2013). The current and projected economic burden of Parkinsons disease in the United States. Movement Disorders, 28(3), 311-318. doi:10.1002/mds.25292

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MDS Abstracts - https://www.mdsabstracts.org/abstract/high-cost-of-medications-for-parkinsons-disease-patients-in-a-rural-population-of-gujarat-india/