1 Recommendations

1.1

Kinesia 360, KinesiaU, PDMonitor, Personal KinetiGraph (PKG) and STAT‑ON are conditionally recommended as options for remote monitoring of Parkinson's disease to inform treatment if:

further evidence is generated, including:
- the impact on resources associated with using the technologies (for people with Parkinson's disease and their carers; see section 4.1)
- the size of impact of using the technologies on symptoms or health-related quality of life (for people with Parkinson's disease and their carers) and how long this lasts for (see section 4.2)
- how frequently the devices are used, and under what circumstances, in the NHS (see section 4.3), and
cost impact is managed (see recommendation 1.2).

1.2

Commissioners should consider the available payment options for the technologies when deciding which to use (for example, pay per use, a subscription model or outright purchase). They should take into account the fact that the technologies may not be needed any more if further data shows they are not cost effective.

1.3

Clinicians should consider features of the devices and how they are used when identifying which may be most suitable for a person, particularly for people with restricted movement, missing limbs, or people who are frail or have cognitive impairment. Clinicians should also support people to set up and operate the remote monitoring devices if needed.

The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through real-world evidence studies.

Why the committee made these recommendations

Monitoring symptoms of Parkinson's disease is important to help clinicians make decisions about a person's care. But this can be difficult in current practice because symptoms can come and go and may be difficult to remember or describe. Review appointments may also be infrequent. Sometimes people with Parkinson's disease may struggle to accurately assess their symptoms, and how severe they think they are may differ from the view of their carer (care partner). More objective monitoring of symptoms is therefore an unmet need. Using these devices could help clinicians to better determine when changes to treatment are needed. This may help better manage symptoms of Parkinson's disease and improve quality of life for people with Parkinson's disease and their carers.

There is a lack of evidence about how much of an impact using the devices in the NHS would have on quality of life for both people with Parkinson's disease and their carers. The devices could help save NHS resources, but it is unclear by how much, and which resources. The amount of evidence for each device varies, and no studies compared 1 device against another. PKG has the most evidence, but how effective it would be when used in the NHS is not certain; this is because in the main trial, people who did and did not have the device had more check ups than they would in the NHS. The device was also used more frequently than would be expected in NHS care.

Having early conditional access to these technologies could improve management of symptoms and quality of life for people with Parkinson's disease and their carers. Data should be collected so that the clinical and cost effectiveness of the technologies can be fully assessed. So, the devices are conditionally recommended as an option to help monitor Parkinson's disease. Clinicians should take into account whether people need help to use the devices, and if 1 device is more suited to a person than others. The devices can only be used if the cost impact is managed by considering the different payment options for the technologies.