Objective: To compare the characteristics, rates, and costs of medically attended falls in patients with Parkinson disease (PD; n=17,421) and patients with PD plus neurogenic orthostatic hypotension (nOH; n=281).

Background: Limited information exists regarding the healthcare cost of nOH in patients with PD.

Design/Methods: PD patients (≥1 PD diagnosis and PD prescription) and PD+nOH patients (≥1 nOH diagnosis and nOH-related prescription plus ≥1 PD diagnosis and PD prescription) were identified using MarketScan® Commercial and Medicare Supplemental databases (1/1/2009–12/31/2013). The index date was defined as the first diagnosis-related medical or prescription claim. Characteristics (12-month pre-index period) and healthcare utilization and costs (12-month post-index period) were compared between groups. Multivariate analyses were used to adjust for baseline differences.

Results: Significantly more PD+nOH than PD patients were aged ≥65 years, male, and had Medicare coverage (P<0.005 for all). Pre-index, PD+nOH (vs PD) patients had significantly higher mean Charlson Comorbidity Index scores (P=0.0084) and rates of syncope/collapse (P<0.0001) and dizziness/giddiness (P<0.0001). Post-index, significant differences were found in the PD+nOH vs PD groups in the proportion of patients who had a medically attended fall (30% vs 21%; P=0.0002) and the mean number of falls among patients who fell (2.5 vs 2.0; P=0.0176). After adjusting for baseline differences, PD+nOH patients had more medically attended falls than PD patients (difference, 0.26; 95% CI, 0.17–0.38). Adjusted costs for the PD+nOH group were higher by $9478 (95% CI, $6336–$12,982) for total costs, $7779 (95% CI, $4679–$11,366) for all-cause medical costs, and $1471 (95% CI, $715–$2553) for fall-related medical costs vs the PD group. Conclusions: Compared with PD patients, PD+nOH patients have a greater disease burden pre-index, as determined by comorbidity assessment and higher rates of syncope/collapse and dizziness/giddiness. Post-index, the PD+nOH group had increased falls and care costs vs the PD group. Whether nOH-directed therapies could impact these outcomes requires additional research.