Cost-utility analysis of a coadjutant telemedicine intervention for fall prevention in Parkinson's disease.

Background And Purpose: Adopting telemedicine (TM) enables improved access to specialized care and reduces barriers. The aim was to assess the cost-utility of a coadjutant multidisciplinary TM programme for fall prevention compared to standard in-office visits for individuals with Parkinson's disease (PD).

Methods: This was an 8-month single-blind randomized controlled trial. TM and control groups received in-office visits and standard management care at baseline, 4 and 8 months. In addition, the TM group received remote multidisciplinary visits for 4 months. Gait, motor and non-motor symptoms, daily living activities, balance and frailty were measured using PD-recommended rating scales and wearable sensors. Clinical characteristics were compared at each visit using baseline scores, gender and age as covariates. The incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs) were calculated at each visit.

Results: Fifty patients were included: 25 patients in the TM group (48% males, mean age 71.1 ± 9.0 years) and 25 patients in the control group (52% males, mean age 69.2 ± 9.4 years). Compared to controls, in the TM group similar QALYs were found but, in contrast, significant improvements in daily living activities, depression, apathy, freezing of gait, balance, quality of life and frailty (all p values <0.05). The use of coadjutant TM intervention in addition to in-office visits was efficient for depression, apathy, freezing of gait, balance and frailty with ICERs, ranging from 91.55 € for non-motor symptoms to 1677.4 € for frailty.

Conclusions: Telemedicine could be considered an efficient coadjutant intervention for PD, especially for non-motor symptoms, enhancing health outcomes and accessibility.