Abstract Background Parkinson’s disease (PD) is characterized by motor and non-motor symptoms that fluctuate as oral medication wears off, causing periods when symptoms return (“OFF” time) and periods of control (“ON” time). These fluctuations often occur at night and early morning. Sleep disturbance (SD) and early-morning OFF time (EMO) have been shown to decrease health-related quality of life (HRQoL) in people with PD (PwP). However, limited evidence exists on how these symptoms impact health state utility values (HSUVs) used in economic modeling. This study aimed to estimate the burden and disutility of SD and EMO in PwP through vignettes valued using the EQ-5D-5 L. Methodology An online survey was completed by adults (≥ 30 years) with self-reported PD diagnosis for ≥ 5 years and ≥ 2 h/day of OFF time, on oral PD medications, and residing in the US or UK. The survey included EQ-5D-5 L and EQ-VAS assessments for 4 vignettes—No SD or EMO, SD (without EMO), EMO (without SD), and Both SD and EMO—plus questions exploring the burden of SD and EMO. EQ-5D-5 L responses were converted into US utility values to estimate HSUVs and the disutility of SD and EMO. Results Seventy-five individuals completed the survey; 52.00% were male, and 78.66% resided in the US. The average age was 64.32 years, with a mean time since diagnosis of 9.82 years and an average OFF time of 3.91 h/day. In the previous week, 96.00% and 98.67% of respondents reported experiencing SD and EMO, respectively. The presence of either SD (HSUV: 0.796) or EMO (HSUV: 0.701) alone resulted in lower EQ-5D-5 L utilities, with the presence of both valued least (HSUV: 0.528), compared with when both SD and EMO were absent (HSUV: 0.911). EQ-VAS scores ranged from 81.01 for no symptoms to 48.41 for both. Conclusions SD and EMO impose a significant burden on PwP and decrease HSUVs. As SD and EMO were associated with significant disutility, they should be incorporated into economic models to comprehensively assess PD treatment benefits. Raising awareness among PwP and healthcare providers and prioritizing treatments that minimize SD and EMO can reduce their burden and improve HRQoL for PwP.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms that significantly impact quality of life. As the disease advances, treatment options expand from oral medications to include device-aided therapies, which differ widely in their mechanisms, invasiveness, and impact on daily life. These therapies have distinct attributes that may align differently with individual patient preferences; therefore, understanding such preferences is crucial for informed, shared clinical decision making. This scoping review synthesizes quantitative evidence on treatment preferences among people with Parkinson’s disease (PwP), highlighting research gaps on key attributes. A systematic search of PubMed and Embase (January 2026) identified studies using quantitative stated-preference methods—discrete choice experiments, best-worst scaling, conjoint analysis, or threshold techniques—with PwP, care partners, or healthcare professionals. Twelve studies met inclusion criteria. Treatment efficacy—particularly increased ‘ON time’ (periods without troublesome dyskinesia)—and treatment modality were the strongest drivers of preferences. PwP favored non-invasive treatments, such as oral or sublingual formulations, over surgical options like deep brain stimulation. Convenience factors, including pill burden and device management frequency, also influenced preferences but were generally secondary to efficacy and modality. Safety attributes, such as risk of depression or cognitive decline, were important but often outweighed by perceived benefits in symptom control. No studies assessed care partners’ preferences for modalities such as subcutaneous infusions. PwP prioritize treatment efficacy and non-invasive modalities, with convenience and safety considered secondary. Further research should explore preferences for new treatment modalities and include care partners’ perspectives to optimize treatment planning and outcomes in PD care.

Introduction: Clinical trials and observational studies have demonstrated that carbidopa/levodopa enteral suspension (CLES) significantly improves advanced Parkinson's disease (aPD) symptoms. This study examined the real-world, long-term impact of CLES on patient-reported outcomes (PROs) in people with aPD. Methods: Pursuing Real-World Outcomes via Duopa Ecosystem (PROviDE) was a 36-month prospective, observational study evaluating the effectiveness of CLES in patients with aPD in the US. PROs were collected at baseline, 3 months, and every 6 months after CLES initiation and included OFF-time, Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9), and Parkinson's Disease Questionnaire-8 (PDQ-8) assessing PD-related quality of life (QoL). Longitudinal treatment effects were evaluated using mixed-effect models. Results: Of 104 patients, 47 (45.2%) provided 36 months of data and were evaluated in the final mixed-model analysis. Patients mean standard deviation (SD) age was 67.0 (8.7) years with a mean (SD) PD diagnosis of 11.0 (6.2) years. Compared with baseline, CLES resulted in statistically significant and clinically meaningful improvements in hours of OFF-time as early as month 3 (mean: -2.7 h/day, p < .0001) and sustained at month 36 (-1.7 h/day, p = .004). Improvements were also observed in treatment effectiveness (≥19 points, all p < .0001), global satisfaction with treatment and convenience of therapy (≥10 points each; all p < .001) over 36 months. A statistically significant improvement in PDQ-8 was observed as early as month 3 (-4.1, p = .001) with no worsening over time. Conclusion: Long-term treatment with CLES provides significant and clinically meaningful reduction in OFF-time, patient's treatment satisfaction, and maintained QoL in the real-world setting.

Treatments for advanced Parkinson’s disease (aPD) are differentiated by efficacy, safety, and modality-related characteristics. As the disease progresses and motor fluctuations worsen, many patients require more frequent dosing or consideration of device-aided therapies, including subcutaneous infusions, intestinal gel delivery systems, or deep brain stimulation. Assessing treatment preferences is valuable to ensure people with aPD (PwP) and care partners (CPs) are satisfied with a treatment’s impact on both motor function and quality of life, potentially increasing adherence and effectiveness. A total of 304 participants (223 PwP, 81 CPs) from the USA, UK, and Germany were included in the study. A discrete choice experiment (DCE) was used to elicit preferences over treatment characteristics. In the DCE, respondents were presented with a series of choice tasks, each consisting of two hypothetical treatments described by varying levels of seven attributes: daily hours of ON time without troublesome dyskinesia (ONwoTD), frequency of early morning OFF time (EMO), risk of mild-to-moderate skin reactions, risk of severe side effects requiring hospitalization, route of administration (ROA), frequency of pill regimen, and frequency of device maintenance. Analyses with a random parameter logit model were used to estimate attribute conditional relative importance (CRI) and explore how people would trade off across attributes. The average PwP age was 65.7 years (SD 8.6), time since diagnosis was 10.0 years (SD 4.4), and self-reported OFF time was 4.0 h/day (SD 2.4). Within the survey design, ROA emerged as the most important attribute (CRI 35.3), followed by hours of ONwoTD (CRI 26.4). All other attributes were of similar importance. Nonsurgical treatments were strongly preferred, with oral pills being the most preferred, followed by infusion device without surgery (subcutaneous infusion). PwP prioritized efficacy (ONwoTD) and ROA when considering treatment options. Understanding these preferences may enhance informed and meaningful decision-making between healthcare providers and PwP.

People with advanced Parkinson’s disease (aPD) frequently experience unpredictable “Off” time and debilitating motor fluctuations. Foslevodopa/foscarbidopa (LDp/CDp), a levodopa/carbidopa (LD/CD) prodrug, is delivered as a 24-h continuous subcutaneous infusion. This post hoc analysis evaluated the efficacy of LDp/CDp in achieving consistent motor symptom control and stable motor states in people with aPD. Diaries of people with aPD treated with LDp/CDp participating in a 12-week, phase 3, randomized controlled trial (RCT) were evaluated versus oral LD/CD, and in a 52-week open-label, single-arm trial (OLT) with LDp/CDp alone. Motor symptom control was assessed by frequency (30-min intervals) and duration (4-h blocks) of motor states (good “On” time [without dyskinesia or troublesome dyskinesia] or “Off” time) over a 16-h waking day. Motor state stability was evaluated by changes in daily motor fluctuations and extreme fluctuations (defined as transition from “Off” to “On” with troublesome dyskinesia, or vice versa). Outcomes were analyzed using adjusted regression models. Analysis included 47 (RCT) and 55 (OLT) people with aPD on LDp/CDp. In the RCT, LDp/CDp had an approximately 1-h gain in good “On” time in the mornings versus a quarter-hour gain for those on LD/CD (P = 0.001), with > 80

We aimed to assess ease of use, convenience, self-efficacy, and satisfaction with long-term use of foslevodopa/foscarbidopa (LDp/CDp), a 24-h continuous subcutaneous infusion therapy delivered via an external portable pump for managing motor fluctuations in people with Parkinson's disease (PwP). PwP using LDp/CDp for ≥ 6 months and enrolled in an open-label study participated in semi-structured interviews, which were qualitatively analyzed using a content and thematic approach. Nineteen adults, with an average (standard deviation) age of 63.6 (10.8) years, disease duration of 9.2 (3.4) years, and duration of LDp/CDp use of 15.4 (3.4) months, were interviewed. Most found LDp/CDp to be user-friendly (89.5

To understand people with advanced Parkinson's Disease (aPD) experience, satisfaction, ease of use, and convenience with the foslevodopa/foscarbidopa (LDp/CDp) delivery system.

Introduction Surgical device-aided therapies (DATs), including carbidopa-levodopa enteral suspension (CLES) and deep brain stimulation (DBS), are efficacious treatment options for people with advanced Parkinson’s disease (aPD). While provider and patient preference influence treatment choices, DAT use remains low and social drivers of health (SDOH) may present barriers to access. This study aimed to evaluate the relationship of patient characteristics and SDOH—including geographic distance to facilities that provide DATs—with likelihood of receiving DAT. Methods Adults diagnosed with PD and meeting aPD clinical indicators were identified among 100% Medicare Fee-for-Service beneficiaries linked to Inovalon’s SDOH data warehouse between 01/01/2018-12/31/2020. Multivariate logistic regression models determined factors associated with DAT vs no-DAT initiation. Results Of 503,245 Medicare beneficiaries with PD, 22% met proxy criteria for aPD, with 2% (2,450) receiving DAT (CLES 24%; DBS 76%). Nationwide aPD prevalence was 309 per 100,000 Medicare beneficiaries. There were 413 DAT facilities nationwide (average 8 facilities/state), and aPD patients traveled 98 miles on average to a facility (range 11-255 miles). aPD patients under age 75 were 2-3x more likely to receive DAT, while those identifying as female, Black race, have moderate to severe comorbidity, and lower household incomes were less likely to receive DAT. Conclusions Findings suggest low utilization of DATs among US Medicare beneficiaries with aPD. Even states with more DAT facilities often require patients to travel long distances. Identifying and minimizing access disparities, particularly for women, racial minorities, and people with low socioeconomic status may improve DAT utilization and outcomes for patients with aPD.

In advanced Parkinson's disease (aPD), ‘ON-time’ indicates periods of better symptom control, with ‘good ON-time (GOT)’ indicating control without troublesome dyskinesia. Despite its importance, the impact of increased ‘GOT’ on aPD outcomes is understudied. This study aims to evaluate the clinical, humanistic, and economic value of incremental hourly increases in ‘GOT’ for people with aPD. The study analyzed data from people with aPD across seven countries, using the Adelphi Parkinson's Disease Specific Program survey (2017–2020). ‘GOT’ (calculated from self-reported ON/OFF-time and the proportion of troublesome dyskinesia time) was normalized to a 16-h day. Outcomes included symptom control, medication use, falls, activities of daily living (ADLs), quality of life (QoL), and healthcare resource utilization (HRU). Regression models evaluated relationships between incremental ‘GOT’ hours and outcomes. Of 802 patients (mean [standard deviation; SD] age, 76.1 [8.9] years; male, 60.3

OBJECTIVES:While factors contributing to dental antibiotic overprescribing have previously been described, previous work has lacked any theoretical behavior change framework that could guide future intervention development. The purpose of this study was to use an evidence-based conceptual model to identify barriers and facilitators of appropriate antibiotic prescribing by dentists as a guide for future interventions aimed at modifying antibiotic prescribing. METHODS:Semi-structured interviews were conducted with dentists from the National Dental Practice Based Research Network (PBRN) exploring patient and practice factors perceived to impact antibiotic prescribing. Audio-recorded telephone interviews were transcribed and independently coded by three researchers. Themes were organized around the COM-B model to inform prospective interventions. RESULTS:73 of 104 dentists (70.1%) were interviewed. Most were general dentists (86.3%), male (65.7%), and white (69.9%). Coding identified three broad targets to support appropriate dental antibiotic prescribing among dentists: (1) increasing visibility and accessibility of guidelines, (2) providing additional guidance on antibiotic prescribing in dental scenarios without clear guidelines, and (3) education and communication skills-building focused on discussing appropriate antibiotic use with patients and physicians. CONCLUSIONS:The findings from our study are consistent with other studies focusing on antibiotic prescribing behavior in dentists. Understanding facilitators and barriers to dental antibiotic prescribing is necessary to inform targeted interventions to improve appropriate antibiotic prescribing. Future interventions should focus on implementing multimodal strategies to provide the necessary support for dentists to judiciously prescribe antibiotics.

Background: Carbidopa-levodopa enteral suspension (CLES) and deep brain stimulation (DBS) are treatment options for PwaPD. While an individuals' preference plays a significant role in choice of treatment, initiation of these surgical DATs may be potentially impacted by health disparities. The objective of this study is to determine the impact of demographic and clinical characteristics, geographic factors, and social determinants of health on initiation of a surgical device-aided therapy (DAT) among people with advanced Parkinson's Disease (PwaPD).

Early, simple predictors for long-term survival in Parkinson’s disease (PD) may help identify patients at elevated risk and are crucial for more personalized treatment. This large, retrospective study examined whether higher levodopa equivalent daily dose (LEDD) a year after diagnosis predicts long-term survival. Mortality risk was increased among 292 patients receiving ≥ 600 mg LEDD versus 2233 patients receiving < 600 mg LEDD (hazard ratio 1.5; 95

Background: Given Parkinsońs disease (PD) heterogeneity, it is challenging to find associations between patients' characteristics and prognosis. We compared long term disease prognosis among people with Parkinson's Disease (PwPD) by treatment intensity in the first year after PD diagnosis.

The 5-2-1 criteria was developed to facilitate the identification and referral of patients with Parkinson’s Disease (PD) inadequately controlled by oral medications. The criterion was not developed to screen patients with PD for device-aided therapy eligibility. The robust design and validation of the 5-2-1 criteria minimizes over or inappropriate referrals, and supports physicians in the timely identification of patients with PD who may warrant further evaluation for treatment optimization. This response letter clarifies concerns raised by Moes et al.

Introduction Studies show that medications for opioid use disorder (MOUD) reduce illicit opioid use, emergency healthcare services, opioid-related overdose, and death. However, few studies have investigated the long-term cost-effectiveness of MOUD in office-based opioid treatment (OBOT) and opioid treatment program (OTP) settings. We aimed to estimate the cost, utility, quality-adjusted life years gained (QALYs), and incremental cost-effectiveness ratios (ICERs) of three MOUD compared to each other and counseling without medication from a US healthcare sector perspective. Methods Our study developed a Markov model to conduct a cost-effectiveness analysis of counseling and three MOUD in the OBOT and OTP settings: sublingual buprenorphine/naloxone (BUPNX), buprenorphine extended-release (XR-BUP) injection, and oral methadone. The model included five health states representing combinations of receiving or off treatment while either using or not actively using illicit opioids, and death. The cycle length was one month; the time-horizon was ten years. The study obtained model inputs from systematic reviews of published literature and public data. A 3 % annual discount rate was applied to cost and utility calculation. The primary outcomes included total costs, life-years (LYs), QALYs, and ICERs. We also conducted a scenario analysis using a hypothetical OBOT outpatient setting with methadone. Results In the base-case OBOT setting, the total costs and QALYs, respectively, were counseling $22,848, 5.60; BUPNX $29,875, 5.82; and XR-BUP $63,936, 5.87. ICERs were $32,345/QALY (BUPNX vs. counseling) and $625,858/QALY (XR-BUP vs BUPNX). In the OTP setting, the total costs of counseling, methadone, BUPNX, and XR-BUP were $20,124, $27,000, $33,500, and $75,272, respectively. QALYs of methadone were 5.86. QALYs of counseling, BUPNX, and XR-BUP remained the same as in the OBOT setting. Incremental ICERs were $26,714/QALY (methadone vs counseling) and $3,337,623/QALY (XR-BUP vs methadone). BUPNX was dominated by methadone. In the scenario analysis, BUPNX was also dominated by methadone. Conclusions Outpatient MOUD resulted in important gains in quality of life and life expectancy. In both OBOT and OTP settings, XR-BUP was not cost-effective. BUPNX was cost-effective in the OBOT setting, while it was dominated by methadone in the OTP setting. The cost-effectiveness of BUPNX and XR-BUP could be enhanced if the costs of these medications were reduced. Abbreviations: BUPNX (Buprenorphine/naloxone), CMS (Centers for Medicare and Medicaid services), CPT (Current procedural terminology), ED (Emergency department), FDA (Food and Drug Administration), ICER (Incremental cost-effectiveness ratios), LY (Life year), MOUD (Medications for opioid use disorder), MTD (Methadone), PSA (Probabilistic sensitivity analysis), OTP (Opioid treatment program), OUD (Opioid use disorder), OWSA (One-way sensitivity analysis), QALY (Quality-adjusted life years gained), SAMHSA (Substance abuse and mental health services administration), SUD (Substance use disorder), US (United States), WAC (Wholesale acquisition cost), WTP (Willingness-to-pay), XR-BUP (Extended-release buprenorphine), XR-NTX (Extended-release naltrexone)