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Medtronic DBS FOR PARKINSON’S DISEASE

Changing the course of Parkinson’s Disease DBS


Why Chang


ge The Course? TURN PAGE AND SEE OUR REASONS!


Quality of Life

In the early stages of PD, patients’ quality of life (QoL) declines and is considerably and increasingly impaired compared as the disease progresses 1

Through the 5 stages of PD PDQ 39

80

60

PDQ 39 of the different stages of PD

DO YOU HAVE PATIENTS WHOSE QUALITY OF LIFE STARTED TO DETERIORATE?

40

20

0 1st 1

2nd

Schrag A, Jahanshahi M, Quinn N. (2000) How does Parkinson’s disease affect quality of life?

3rd

4th

5th


Quality of Life Improvement for patients with early motor complications (EARLYSTIM study) PDQ 39 Medical Therapy

Medtronic DBS Therapy

The EARLYSTIM study has demonstrated that Medtronic DBS provides superior efficacy vs. best medical treatment alone with 26% improvement in Quality of Life.

NO OTHER TREATMENT FOR PD IMPROVES QAUALITY OF LIFE TO A SIMILAR EXTENT AS DOES MEDTRONIC DBS!

35

DBS

30

1% WORSENING

vs.

25

20

26% IMPROVEMENT 15

10 0

5 months

12 months

18 months

24 months


Quality of Life

In the early stages of PD, patients’ quality of life (QoL) declines and is considerably and increasingly impaired compared as the disease progresses 1

Through the 5 stages of PD

PDQ 39

80

60

PDQ 39 of the different stages of PD

DO YOU HAVE PATIENTS WHOSE QUALITY OF LIFE STARTED TO DETERIORATE?

40

20

0 1st 1

2nd

3rd

Schrag A, Jahanshahi M, Quinn N. (2000) How does Parkinson’s disease affect quality of life?

4th

5th


Quality of Life Improvement for patients with early motor complications (EARLYSTIM study)

The EARLYSTIM study has demonstrated that Medtronic DBS provides superior efficacy vs. best medical treatment alone with 26% improvement in Quality of Life.

PDQ 39 Medical Therapy

Medtronic DBS Therapy

80

NO OTHER TREATMENT FOR PD IMPROVES QAUALITY OF LIFE TO A SIMILAR EXTENT AS DOES MEDTRONIC DBS!

60

40

DBS

1% WORSENING

vs.

20

26% IMPROVEMENT 0 0

5 months

12 months

18 months

24 months


Progression of Parkinson’s Disease

Medical therapy (dopaminergic drugs such as oral levodopa) is the standard of care and an effective treatment for control of motor symptoms in early Parkinson’s disease (PD).

Without Medtronic DBS

As the disease progresses i, standard medical therapy becomes less effective and the majority of patients develop medication-induced motor complications: dyskinesias2 and motor fluctuations. • disease-related symptoms (on-off fluctuations and/or dyskinesias and/or tremor) and/or • side effects related to anti-parkinsonian medication (hyper-dopaminergic (e.g. gambling, hypersexuality, hypomania) and/or anti-cholinergic symptoms) having an impact on quality of life Approximately 25% develop complications between 2.5-3.5 years, and up to 40% between 4-6 years after diagnosis 2 (Ahlskog 2001)

1.

EARLY PHASE

1.

2

2.

3.

INTERMEDIATE PHASE

Adequate symptom control

2.

4. LATE PHASE

Worsening of motor symptoms

3.

Declining quality of life

Ahlskog, Frequency of Levodopa-Related Dyskinesias and Motor Fluctuations as Estimated From the Cumulative Literature, Movement Disorders Vol. 16, No. 3, 2001, pp. 448–458

4.

Cognitive deficit


Progression of Parkinson’s Disease

With Medtronic DBS earlier, patients could have a longer favorable course of their disease, by delaying motor fluctuations 3

With Medtronic DBS

Medtronic DBS changes the disease course in the sense that levodopasensitive complications of PD are postponed The EARLYSTIM RCT is the first to demonstrate that DBS may be a therapeutic option for patients at an earlier stage of disease progression, as soon as 4 years after PD diagnosis, if motor complications have occurred. 4

STAGE 1 BROUGHT BACK!

1.

2.

1.

STAGE 3 SHORTENED!

2.

3.

4.

DBS EARLY PHASE

1.

3 4

INTERMEDIATE PHASE

Adequate symptom control

2.

LATE PHASE

Worsening of motor symptoms

3.

Declining quality of life

Deuchl, Agid ; Subthalamic neurostimulation for Parkinson’s disease with early fluctuations: balancing the risks and benefits; Lancet Neurol 2013; 12: 1025–34 Schupbach WM, Rau J, Knudsen K, et al. Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 2013; 368: 610–22.

4.


Annual cost

The annual costs associated with early stage PD is high and ranges from €7,180 to €19,500 5

Assosiated with early stage PD

COST [EUR]

1 in 2 Patients with PD will have ceased work by 5 years from diagnosis 6 causing significant economic burden.

Indirect* / Social Services** Costs

20.000

15.000

DO YOU HAVE PATIENTS WHO NEED TO RETIRE EARLIER BECAUSE OF PD?

10.000

5000

UK **

5 6

SWEDEN *

Lindgren P et al (2005) Cost of Parkinson’s disease in Europe. European Journal of Neurology 12 (Suppl 1): 68-73. Murphy et al. (2013) Parkinson’s disease: how is employment affected? Ir J Med Sci (2013) 182:415–419

GERMANY *


Annual Cost Postponing later stages of pd with medtronic DBS may lead to potentially signifficant economic benefits based on reduction in direct medical cost and lost income. 7

“I almost lost my job because the tremor became worse and I couldn´t do any handwriting any more... Now, 4 years after surgery I am still in duty and even received a promotion 3 years ago”

DBS

THOMAS (44) Police officer, Germany 7

“With Medtronic DBS, I can do my job, I can pursue my hobbies, I can take care of my kids… this is for me the true happiness”

DBS

STEFAN (36) Germany

The reductions in PD drug use in DBS patients translates into cost savings of 54% (from €22 to €10, daily per patient drug cost), while the drug costs in BMT patients increased (from €17 to €20, daily per patient drug costs) i i. This represents cost savings of €5,220 per patient per year, if costs are assumed constant for 1 year. For some patients DBS also enables work:

DBS

GILLES (59) Journalist, France

Johnson et al (2012) An economic model of Parkinson’s disease: implications for slowing progression in the United States. Mov Disord. 2013 Mar;28(3):319-26.

Before the surgery I had challenges at work because of the STIGMA. The kids were mimicking my tremor, and that was clearly not fun. Having the Medtronic brain pacemaker I can work again normally”


Why wait with offering dbs to the right patients? 1. Clear Diagnosis of PD 2. Good response to Levodopa

MEDTRONIC IS THE LEADER IN DBS COMBINING QUALITY OF LIFE, CONFIDENCE AND EXPERIENCE FOR MORE THAN 25 YEARS

3. When the patient’s quality of life is impacted due to

Disease-related symptoms (on-off fluctuations and/or dyskinesias and/or tremor) and/or

Side effects related to anti-parkinsonian medication

(hyper-dopaminergic (e.g. gambling, hypersexuality, hypomania) and/or anti-cholinergic

symptoms)

4. Absence of medical conditions preventing surgery 5. Absence of ongoing severe, medically-resistant neuropsychiatric diseases (e.g. severe depression, severe cognitive impairment)

6. Realistic expectations and good family support


LEARN MORE AT

www.medtronic.eu

i Hoehn and Yahr (H&Y) staging: The H&Y rating scale of 6 stages of the disease’s severity and disability: 0 (no signs of Parkinson’s disease; 1 (unilateral symptoms);

2 (bilateral symptoms, no balance impairment); 3 (mild/moderate disability with impaired postural reflexes, physically independent); 4 (severe, still able to walk); 5 (wheelchair bound or bed-ridden unless aided). For patient selection in EARLYSTIM, H&Y was measured in patients ON medication ii

Methodology for calculation of PD drug costs: PD drug costs were calculated using detailed information on PD medication use (drug name; and number of patients and daily dosage for each drug) for the DBS and BMT arms at baseline and 24 months. German unit costs (a cost per mg, as per the standard reference for list prices “Rote Liste”) were assigned to the total mg used for each drug to arrive at a daily cost per drug. These were summed up to a total drug cost/day for the DBS and BMT arms at baseline and 24 months, and divided by total number of patients in each arm to arrive at a drug cost per patient/per day for DBS and BMT at baseline and 24 months.


United Kingdom/Ireland

Europe

Medtronic UK Ltd. Building 9 Croxley Green Business Park Watford Hertfordshire WD18 8WW UK www.medtronic.co.uk Tel: +44 (0)1923 212213 Fax: +44 (0)1923 241004

Medtronic International Trading SĂ rl. Route du Molliau 31 Case postale CH-1131 Tolochenaz www.medtronic.eu Tel: +41 (0)21 802 70 00 Fax: +41 (0)21 802 79 00


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