Medtronic DBS

Changing the course of Parkinson’s Disease

FOR PARKINSON’S DISEASE

DBS

Why Change The Course?

Why Change The Course?TURN PAGE AND SEE OUR REASONS!

Quality of Life

PDQ 39

0

1st

PDQ 39 of the different stages of PD

2nd 3rd 4th 5th

20

40

60

80

Through the 5 stages of PD

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

compared as the disease progresses 1

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

10

15

20

25

30

35

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

Quality of Life

PDQ 39

10

5 months

Medical Therapy Medtronic DBS Therapy

1% WORSENING

vs.26% IMPROVEMENT

0 12 months 18 months 24 months

15

20

25

30

35

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.

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

DBS

Quality of Life

PDQ 39

0

1st

PDQ 39 of the different stages of PD

2nd 3rd 4th 5th

20

40

60

80

Through the 5 stages of PD

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

compared as the disease progresses 1

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

0

20

40

60

80

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

Quality of Life

PDQ 39

0

5 months

Medical Therapy Medtronic DBS Therapy

1% WORSENING

vs.26% IMPROVEMENT

0 12 months 18 months 24 months

20

40

60

80

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.

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

DBS

Progression of Parkinson’s Disease

Adequate symptom control

EARLY PHASE INTERMEDIATE PHASE LATE PHASE

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).

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)

Worsening of motor symptoms Declining quality of life

Without Medtronic DBS

1.

1.

2.

2.

3.

3.

4.

4.

Cognitive deficit

2 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

Progression of Parkinson’s Disease

EARLY PHASE INTERMEDIATE PHASE LATE PHASE

Adequate symptom control

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

Medtronic DBS changes the disease course in the sense that levodopa-sensitive 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

Worsening of motor symptoms Declining quality of lifeCognitive deficit

With Medtronic DBS

1.

1.1.

2.

2.2.

3.

3.

4.

4.

STAGE 1 BROUGHT BACK! STAGE 3

SHORTENED!

DBS

4 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.

3 Deuchl, Agid ; Subthalamic neurostimulation for Parkinson’s disease with early fluctuations: balancing the risks and benefits; Lancet Neurol 2013; 12: 1025–34

Cognitive deficit

Annual cost

COST [EUR]

SWEDEN *UK ** GERMANY *

Indirect* / Social Services** Costs

5000

10.000

15.000

20.000

Assosiated with early stage PD

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

1 in 2 Patients with PD will have ceased work by 5 years from diagnosis 6

causing significant economic burden.

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

6 Murphy et al. (2013) Parkinson’s disease: how is employment affected? Ir J Med Sci (2013) 182:415–419

5 Lindgren P et al (2005) Cost of Parkinson’s disease in Europe. European Journal of Neurology 12 (Suppl 1): 68-73.

THOMAS (44) STEFAN (36) GILLES (59)Police officer, Germany Germany Journalist, France

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:

Annual CostPostponing 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”

“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”

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”DBS DBS DBS

7 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.

Why wait with offering dbs to the right patients?

Clear Diagnosis of PD

Good response to Levodopa

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)

Absence of medical conditions preventing surgery

Absence of ongoing severe, medically-resistant neuropsychiatric diseases

(e.g. severe depression, severe cognitive impairment)

Realistic expectations and good family support

1.2.

3.

4.

5.

6.

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

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

i i 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.

Europe

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United Kingdom/Ireland

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