 |
 |
Brian, I have had PD for about 10 years and was diagnosed 6 years ago. I have been taking sinemet since diagnosis along with about every imaginable agonist and adjunct medication on the market. I had a pallidotomy (unilateral-I have a scheduled appointment with the neurosurgeon on March 2nd to decide whether to do the other side) at a cost of a little over $13,000. I have only been able to reduce the Sinemet to about 1000mg/day from 1600mg/day due to the introduction of Mirapex into my schedule. I am currently taking 3mg of Mirapex a day although we may try to up that to 4.5mg to try to reduce the Sinemet further as I still experience dyskinesias on the unaffected side. However, I feel that cost effectiveness takes a back seat to human kindness in any medical decision witin reason. A lot of what is happening in the area of managed care disturbs me. Driving cost down is good to a point. But when the decision crosses the line between a doctor or a drug company based just on financial considerations it brings ethics into the arguement. An example of this is Primary Care Physicians in some HMOs are paid a flat yearly rate for each of their patients no matter how many visits they incur. It doesn't take a genius to figure a scenario where the doctor has to answer the financial dilema he/she is faced with. For example, a person goes to the primary care physician every time they sneeze. The doctor's bookkeeper points this out to he/she. The next time the patient comes in they have a serious problem that can be saved by timely treatment. Only the doctor remembers what the bookkeeper says and tells that person to come only when it is more serious. He neglects the patients by not even listening to the problem and lectures the patient about wasting his time and money. We all can create an ending to this hypathetical situation for ourselves that would have dire consequences. People there are certain aspects of out health care system that need fixing. I am not smart enough to offer the answers. We do as concerned patients and care givers need to speak up when we see examples we don't agree with. I have a responsibility to my customers(employees of the company I work for)as HR Director, to defend them with every ounce of energy I can muster when they are being made pawns by insurance industries and the managed care system. The next target for the managed care system is drug companies. Keep your eyes and ears open as to the direction and how they will steer an industry extremely essential to all us. I have been told that the focus will be on making it much more attractive to buy generic by adjusting or elilminating the copay on brand names. We should all make them aware of the negative impact that it would have on us. Regards, Greg Leeman 37/6 [log in to unmask] -----Original Message----- From: Barbara Mallut <[log in to unmask]> To: Multiple recipients of list PARKINSN <[log in to unmask]> Date: Sunday, February 08, 1998 7:08 PM Subject: Re: costs of pallidotomy >Brian..... > >I've had PD for about 22 years, was diagnosed 14 years ago, have been on >Sinemet for 10 years, and had a unilateral pallidotomy 4 years ago (with >outstanding results) <thankfully>. > >With today's available Parkinson's meds, the drugs are a "daily thing," and at >this point, with the available drugs, that's "daily," as in "forever." (the >lifetime of the patient) The surgery is a once or, depending, >twice-in-a-lifetime event. Therefore, the monetary "investment" a person with >Parkinson's has in their drugs rises exponentially over the years, while the >"investment" in the surgery(s) is a "once or twice in a lifetime expense. > >Also, as far as I know, anyone having a pallidotomy still is required to take >PD meds daily - tho often the dosage is reduced post-surgery. > >My pallidotomy cost $30,000. Goodness-only-knows how much my drugs have cost >(so far!), because I've always been able to get the drugs via my HMO at $7 for >a three month supply per prescription. Since I take 2 types of Sinemet >(regular and CR) daily, plus one other drug, that'd be $21 every 3 months for >PD meds. If II had to pay retail, I simply wouldn't be able to afford PD >drugs - or any other meds! THAT stuff COSTS! > >Sooooo, Brian, in my opinion, to compare the costs (as well as the >treatment-value) of PD drugs verses pallidotomy is like comparing apples to >giraffes. > >It doesn't compute! > >Barb Mallut >[log in to unmask] >---------- >From: Parkinson's Information Exchange on behalf of Brian Skotko >Sent: Sunday, February 08, 1998 3:24 PM >To: Multiple recipients of list PARKINSN >Subject: costs of pallidotomy > >Dear friends, > >I am an undergraduate a Duke University doing research on Parkinson's >Disease, mainly comparing levodopa treatments with that of pallidotomy. I >would be most interested in any data on the relative expense of these two >treatments. While I realize that individual treatments may vary, is >pallidotomy generally more cost effective then continued use of levodopa >treatments? Or is the surgery, on the contrary, much more expensive in the >long term? > >Thanks you so much for your help and concern. > >Sincerely yours, >Brian Skotko > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > BRIAN G. SKOTKO > Duke University Home address: > Box 92275 16987 Stag Thicket Ln. > Durham, NC 27708 Strongsville, OH 44136 > Phone: (919) 613-1427 Phone: (440) 238-2964 > E-mail: [log in to unmask] E-mail: [log in to unmask] > http://www.duke.edu/~bgs2/brian.htm >~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ >