Parkinson’s Disease : Breaking Down the Cost of Treatment In India

Parkinson’s disease (PD) is a long-term neurological disorder that leads to progressive disability. It mainly affects movement, causing symptoms like slow movements, difficulty with balance, tremors, muscle stiffness, and freezing (when you can’t move temporarily). In addition to these movement problems, people with PD often experience non-motor issues like anxiety, depression, tiredness, constipation, sleep disturbances (like acting out dreams), and memory or thinking difficulties. As Parkinson’s disease progresses, people with PD become more prone to falls and injuries. The variety of symptoms linked to the disease creates a heavy burden, not only for the individual and their family but also for the healthcare system and society as a whole. 

India has the largest population in the World, with advancing technology and healthcare, life expectancy is increasing rapidly. Geriatric medicine is the emerging specialty to counter the problems of elderly population. Age-adjusted prevalence in the Indian population is estimated to be 52.8 per 1,00,000 population. As per statistics our country is leading in the number of patients diagnosed from Parkinson’s disease which is approximately 15% to 43% of 1,000,000 people. 

These numbers are of public health concern and economic burden for the nation. The cost of treatment is based on direct and indirect expenditures. AI-Afiya Medi Tour helps patients to find the best possible treatment keeping in mind the cost and care you desire! Read ahead to understand the cost of Parkinson’s disease in India. 

Causes of Parkinson’s disease

The main symptoms of Parkinson’s disease arise when nerve cells in the brain’s basal ganglia, which control movement, become damaged or die. These neurons normally produce dopamine, a chemical crucial for smooth and coordinated movements. When they deteriorate, dopamine levels drop, leading to the movement difficulties seen in Parkinson’s. Although scientists have identified risk factors like age, genetics, and environmental exposures, the exact reason why these neurons die is still not fully understood. 

1. Age

• Primary Risk Factor: Age is the most significant risk factor for Parkinson’s disease. The risk increases with age, especially after the age of 51. Although early-onset Parkinson’s can occur, it is less common.

2. Genetic Factors

• Family History: A small percentage of PD cases (10-15%) are linked to inherited genetic mutations. Having a family member with Parkinson’s increases the risk, though most cases are sporadic (non-familial).
• Specific Gene Mutations: Mutations in certain genes, such as LRRK2, PINK1, PRKN, and SNCA, are associated with the disease. These mutations are more common in early-onset PD.
• Ethnic Variations: Certain populations, like Ashkenazi Jews and North Africans, have a higher frequency of some PD-related genetic mutations.

3. Environmental Factors

• Exposure to Pesticides and Herbicides: Prolonged exposure to pesticides and herbicides, particularly in rural areas, has been linked to a higher risk of developing Parkinson’s. Chemicals like paraquat and rotenone have been associated with increased risk.
• Heavy Metal Exposure: Chronic exposure to metals such as manganese and lead has been suggested to play a role in the development of Parkinson’s.
• Industrial Chemicals: Exposure to solvents like trichloroethylene (TCE), commonly used in industrial settings, may also increase the risk.
• Living in Rural Areas: People who live in rural environments, where pesticide use is more prevalent, may be at greater risk.

4. Oxidative Stress and Mitochondrial Dysfunction

• Oxidative Stress: Excessive oxidative stress, which damages cells and DNA, has been linked to the death of dopamine-producing neurons in Parkinson’s.
• Mitochondrial Dysfunction: Impaired energy production in cells due to mitochondrial dysfunction has been implicated in the progression of PD. Cells with reduced mitochondrial activity are more susceptible to damage.

5. Inflammation

• Chronic Brain Inflammation: Long-term inflammation in the brain may contribute to the death of neurons involved in movement. Studies show that people with chronic inflammatory conditions may have an increased risk of PD.

6. Gut-Brain Connection

• Gastrointestinal Issues: Emerging research suggests that Parkinson’s may begin in the gut. Symptoms like constipation can precede motor symptoms by years, and abnormal protein aggregates (alpha-synuclein) have been found in the gut of PD patients.

7. Head Trauma

• Traumatic Brain Injury (TBI): People who have suffered repeated head injuries (e.g., athletes or military personnel) have an elevated risk of developing Parkinson’s. TBIs can cause long-term damage to neurons in the brain, making them more vulnerable to degeneration.

8. Gender

• Higher Risk in Men: Men are more likely to develop Parkinson’s disease than women. The reasons for this are not fully understood, but hormonal differences or environmental exposures may contribute.

9. Lifestyle Factors

• Lack of Physical Activity: A sedentary lifestyle has been associated with a higher risk of developing PD. Regular exercise may protect against the disease.
• Smoking and Caffeine Consumption: Interestingly, smokers and people who consume caffeine regularly are found to have a reduced risk of PD. However, the reasons for this are not fully clear, and smoking carries other significant health risks.

10. Infections and Autoimmune Disorders

• Viral Infections: In rare cases, viral infections (such as encephalitis lethargica) have been linked to the development of Parkinson-like symptoms. Inflammation following infections might contribute to neuronal damage.
• Autoimmune Responses: There is evidence suggesting that autoimmune mechanisms, where the body attacks its own tissues, could play a role in the degeneration of neurons in PD.

 Cost of Care of Parkinson’s Disease

The cost of care for patients is divided into direct and indirect costs. Direct cost includes drugs, surgery and hospital stay whereas indirect cost includes loss of job or income for family and institution, mental strain for caregivers and social costs. 

Every disorder has its journey from diagnosis to surgery to post care! Discovering the one with Parkinson’s can be challenging. Here is a list of options in terms of medication and surgery. This will add to the total direct cost of the treatment. At the AI-Afiya Medi Tour we guide our patients to choose the best for them!

Here are some medications used for Parkinson’s disease. 

Carbidopa-Levodopa: Levodopa is converted to dopamine in the brain, helping treat Parkinson’s disease. 

Inhaled Carbidopa-Levodopa: Delivered via a tube into the small intestine, this formulation requires a surgical procedure.

Dopamine Agonists: These drugs mimic dopamine in the brain without converting into it.

MAO B Inhibitors: Selegiline, rasagiline, and safinamide block the breakdown of dopamine by inhibiting the enzyme MAO B.

The cost is variable depending on the dose and usage. Average cost of dopaminergics is around 8,000 rupees and non-dopaminergics is 3500 rupees on an annual basis. Average cost of medications can go about 5 lakh to 8 lakhs per year. This is quite low compared to other countries. The average cost includes direct and indirect expenditure as well. Parkinson’s cost of treatment in India is bearable considering other countries. Best hospitals include Medicity and Max Super Speciality Hospital in Gurugram. 

If all these medications fail, patients can opt for Deep Brain Stimulation better known as awake surgery for the patient. The average cost is 25,000 rupees per session. Annual expenditure can go around 12 lakhs in Indian rupees, much lower than the developed countries. 

Produodopa :  Life changing drug for patients 

Many patients pop up 20 drugs each day to work and feed themselves. The drugs work unsystematically on symptoms not providing much relief. Produodopa is a new drug which will work continuously to provide dopamine. The drug is still not available in India and USA, but will be rolled out soon for 1000 patients in the NHS according to BBC. 

Produodopa is a combination of two drugs foslevodopa and carbidopa. Foslevodopa works by converting into dopamine, a chemical that helps transmit signals between the brain and nerves responsible for controlling movement, effectively managing Parkinson’s symptoms like tremors and excessive movement. The treatment is delivered continuously through a cannula under the skin, controlled by a small automatic pump that provides a steady 24-hour infusion to maintain symptom control. Additionally, it offers a manual boost option for extra relief when needed. Many patients who previously relied on numerous tablets experience worsening symptoms later in the day and at night, making this infusion system a more consistent and effective alternative.

Frequently Asked Questions

What are some of the challenges associated with long-term treatment of Parkinson’s disease?

Long-term treatment of Parkinson’s disease presents several challenges. Over time, patients often develop a reduced response to medications like levodopa, which is the standard treatment. This leads to fluctuations in symptom control, including “on-off” periods where mobility can suddenly worsen. Additionally, long-term use of these medications may cause side effects such as dyskinesia (involuntary movements). As the disease progresses, non-motor symptoms like cognitive decline, depression, and sleep disorders become more prominent, complicating treatment further. Managing these issues often requires multiple therapies and careful monitoring, but the complexity of balancing treatments poses significant challenges for both patients and clinicians.AI-Afiya Medi Tour helps patients to find the best possible treatment keeping in mind the cost and care you desire!

What tests and assessments are typically used?

Diagnosing Parkinson’s disease is primarily clinical, based on a patient’s symptoms and medical history. Neurologists use the Unified Parkinson’s Disease Rating Scale (UPDRS) to evaluate motor and non-motor symptoms. A physical exam assesses tremors, muscle rigidity, bradykinesia (slow movement), and balance. DaTscan, an imaging test, can help visualise dopamine transporter levels in the brain, supporting diagnosis. MRI or CT scans are often used to rule out other neurological conditions that mimic Parkinson’s. Additionally, response to levodopa therapy may be tested, as improvement with this medication supports the diagnosis. No single definitive test exists, so diagnosis involves a combination of assessments. AI-Afiya Medi Tour helps patients to find the best possible treatment keeping in mind the cost and care you desire!

What are the main risk factors for developing Parkinson’s disease?

The main risk factors for developing Parkinson’s disease include age, with most cases occurring in individuals over 60. Gender plays a role, as men are more likely to develop the disease than women. Genetics is another factor, with a family history of Parkinson’s increasing the risk, especially if specific gene mutations are involved. Environmental factors, such as prolonged exposure to pesticides, herbicides, or heavy metals, are linked to a higher risk. Additionally, people with a history of head injuries may be more susceptible. However, smoking and caffeine consumption have been associated with a slightly lower risk of developing Parkinson’s.

Am I a good candidate for deep brain stimulation or other surgical treatments?

To be a good candidate for deep brain stimulation (DBS) or other surgical treatments for Parkinson’s disease, several factors are considered. Typically, DBS is recommended for patients whose symptoms are not adequately controlled by medication but who still respond to levodopa. Candidates should have significant motor fluctuations or dyskinesias, and their condition should have progressed to where daily activities are affected. Those without severe cognitive impairment or psychiatric disorders are preferred. DBS is generally more effective for younger patients, but age alone isn’t a strict criterion. A thorough evaluation by a neurologist and neurosurgeon will determine if surgery is appropriate. Talk to experts at AI-Afiya Medi Tour to get an apt understanding of treatment. Our team helps you creating most effective plans! 

Are there any ongoing costs related to the surgery, such as maintenance or follow-up care?

Yes, there are ongoing costs related to deep brain stimulation (DBS) surgery. After the procedure, patients require regular follow-up visits for programming and adjusting the DBS device, which ensures it is working effectively. These follow-up appointments may involve neurologists and specialized technicians. Additionally, the battery in the DBS device may need to be replaced every few years, which can incur further costs. There may also be maintenance for any complications or issues that arise with the device. While most of these expenses are typically covered by insurance, it’s important for patients to plan for ongoing care and associated costs. Talk to experts at AI-Afiya Medi Tour to get an apt understanding of treatment. Our team helps you creating most effective plans!