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Neurology. 2015 Feb 24;84(8):794-802. doi: 10.1212/WNL.0000000000001282. Epub 2015 Jan 28.

Placebo effect of medication cost in Parkinson disease: a randomized double-blind study.

Author information

1
From the UC Neuroscience Institute, Department of Neurology (A.J.E., C.B., J.P.S.), and Department of Internal Medicine (M.J.L.), University of Cincinnati; Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E.), Cincinnati; University of Cincinnati Center for Imaging Research (M.M.N., J.C.E., M.S.S., D.E.F.), OH; Division of Biostatistics and Epidemiology (A.D.), Texas Tech University Health Sciences Center, El Paso; The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.E.L.), University Health Network and the University of Toronto, Canada; University of Alabama at Birmingham (J.B.A., J.P.S.); and Department of Veterans Affairs Medical Center (M.J.L.), Research Service, Cincinnati, OH. alberto.espay@uc.edu.
2
From the UC Neuroscience Institute, Department of Neurology (A.J.E., C.B., J.P.S.), and Department of Internal Medicine (M.J.L.), University of Cincinnati; Gardner Family Center for Parkinson's Disease and Movement Disorders (A.J.E.), Cincinnati; University of Cincinnati Center for Imaging Research (M.M.N., J.C.E., M.S.S., D.E.F.), OH; Division of Biostatistics and Epidemiology (A.D.), Texas Tech University Health Sciences Center, El Paso; The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.E.L.), University Health Network and the University of Toronto, Canada; University of Alabama at Birmingham (J.B.A., J.P.S.); and Department of Veterans Affairs Medical Center (M.J.L.), Research Service, Cincinnati, OH.

Abstract

OBJECTIVE:

To examine the effect of cost, a traditionally "inactive" trait of intervention, as contributor to the response to therapeutic interventions.

METHODS:

We conducted a prospective double-blind study in 12 patients with moderate to severe Parkinson disease and motor fluctuations (mean age 62.4 ± 7.9 years; mean disease duration 11 ± 6 years) who were randomized to a "cheap" or "expensive" subcutaneous "novel injectable dopamine agonist" placebo (normal saline). Patients were crossed over to the alternate arm approximately 4 hours later. Blinded motor assessments in the "practically defined off" state, before and after each intervention, included the Unified Parkinson's Disease Rating Scale motor subscale, the Purdue Pegboard Test, and a tapping task. Measurements of brain activity were performed using a feedback-based visual-motor associative learning functional MRI task. Order effect was examined using stratified analysis.

RESULTS:

Although both placebos improved motor function, benefit was greater when patients were randomized first to expensive placebo, with a magnitude halfway between that of cheap placebo and levodopa. Brain activation was greater upon first-given cheap but not upon first-given expensive placebo or by levodopa. Regardless of order of administration, only cheap placebo increased activation in the left lateral sensorimotor cortex and other regions.

CONCLUSION:

Expensive placebo significantly improved motor function and decreased brain activation in a direction and magnitude comparable to, albeit less than, levodopa. Perceptions of cost are capable of altering the placebo response in clinical studies.

CLASSIFICATION OF EVIDENCE:

This study provides Class III evidence that perception of cost is capable of influencing motor function and brain activation in Parkinson disease.

PMID:
25632091
PMCID:
PMC4345649
DOI:
10.1212/WNL.0000000000001282
[Indexed for MEDLINE]
Free PMC Article

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