Study: Reduce long-term care use among patients with Parkinson’s disease psychosis

Reducing long-term care utilization among patients with Parkinson’s disease psychosis (PDP) may lower overall economic burden, according to data presented at the American Managed Care Pharmacy 27th Annual Meeting & Expo in San Diego.

PDP is a burdensome aspect of Parkinson’s disease characterized by hallucinations and delusions, and affects more than half of all patients over the course of their disease. 

This retrospective observational study used pooled data from the Medicare Current Beneficiary Survey (MCBS) Cost and Use files 2000-2010, linked to Medicare claims.

The MCBS is a nationally representative, random sample survey conducted by the Centers for Medicare & Medicaid Services designed to evaluate annual healthcare utilization and expenditure of Medicare beneficiaries. MCBS reports on health insurance coverage, expenditures, and sources of payment for all services used by Medicare beneficiaries, including non-covered services.

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A descriptive comparison of costs and utilization among Medicare populations was conducted by study author Kari Edwards, PhD, principal, Health Economics and Market Access; ICON Commercialisation and Outcomes and colleagues. All-cause healthcare costs were examined for the years 2000 to 2010 among Medicare beneficiaries with PDP, compared with Medicare beneficiaries with Parkinson’s disease, and all Medicare beneficiaries enrolled.

The findings of the work reported at AMCP underscore the economic burden of PDP in the United States.

• Relative to patients with Parkinson’s disease overall, a higher percentage of those with psychotic symptoms spent time in long-term care.
• 68.8% of PDP patients, 51.8%of Parkinson’s patients and 37.4% for the overall Medicare group

• Patients with PDP spent more time in long-term care facilities compared to the other groups.
• Average of 143 days for PDP patients, 89 for Parkinson’s patients and 24 for the overall Medicare group

• Psychotic symptoms are associated with additional costs in both the inpatient setting and in the long-term care setting.
• Inpatient setting: Average all-cause annual reimbursement of $7,877 for PDP patients and $6,263 for Parkinson’s disease patients

• Long-term care setting: Average annual reimbursement of $25,197 for PDP patients and $15,433 for Parkinson’s patients

• PDP patients averaged higher total all-cause reimbursement than both PD and Medicare groups.
• PDP patients averaged $54,387, Parkinson’s patients averaged $40,399 and Medicare groups averaged $19,373

“Cost estimates of PDP are hampered by clinical under-diagnosis and multiple care settings,” says Edwards. “As such, this study utilized multiple years of linked Medicare survey-claims data to determine costs associated with a claims-based diagnosis of PDP. This study is a descriptive assessment of the costs of care among Medicare beneficiaries with PDP. There are very few studies assessing patient-level costs of care for PDP in the literature, and those studies that have been published have limitations [ie, they utilize modeling techniques or were conducted with comparatively old data]”.

Currently there is no FDA-approved treatment indicated for PDP, according to Edwards. “Rather, PDP symptoms sometimes are treated with atypical antipsychotics, which unfortunately can worsen the symptoms of Parkinson’s disease. Of particular concern, the package insert for these drugs includes a black box warning regarding the increased morbidity and mortality in elderly patients.

“Managed care and formulary decision makers must promote quality care while controlling cost,” she adds. “These findings are pertinent, as they point to an increased economic burden among PDP patients.”

The research was financially supported by ACADIA Pharmaceuticals Inc.

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