Objective: To examine the availability of PD treatment by country, and analyse differences by national income as defined by the World Bank (high income countries (HIC), upper middle income countries (UMIC), lower middle income countries (LMIC) and low income countries (LIC)) and world region.

Background: The prevalence of Parkinson’s disease (PD) is increasing around the world. Treatment options for PD include drugs, device-aided therapies (e.g. deep brain stimulation, levodopa-carbidopa intestinal gel, apomorphine) and non-pharmacological therapies (physiotherapy, occupational therapy, speech and language therapy (SLT)). Complementary and alternative therapies (CATs), such as Mucuna pruriens, are also used in some countries.

Method: This study was conducted by surveying members of the International Parkinson and Movement Disorders Society about access to PD treatment. LMIC and LIC were analysed together.

Results: There were 352 valid responses from 76 different countries, 41.5% from HICs, 30.4% from UMICs and 28.1% from LMICs and LICs. Levodopa was widely available at a country level (99% of all countries). Access to other PD drugs decreased with national income. Access to device-aided therapies decreased with income; 100% of responses from HICs reported availability compared to 92.5% among UMICs and 57.6% among LMICs. Greater disparity existed for levodopa-carbidopa intestinal gel than for deep brain stimulation and apomorphine. A similar trend was observed for CATs (37.0% availability in HICs, compared with 31.8% in UMICs and 19.2% in LMICs). Of the non-pharmacological therapies, physiotherapy was the most available (>90% respondents). Occupational therapy and SLT were less available in LMICs (49.5% and 55.6% respectively) compared to HICs (80.1% and 84.9%).

Conclusion: Our survey highlights significant discrepancies in access to PD treatments between countries and in relation to national income. This is particularly concerning given that PD prevalence may be rising at a higher rate among LMICs compared to HICs. Improving access to PD treatment should be a focus of greater study and intervention.  Within-country variation in access to PD treatments is also an area in need of investigation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/global-access-to-parkinsons-disease-treatment/