Impact of Neurogenic Orthostatic Hypotension on Healthcare Costs in Patients with Parkinson Disease

Impact of Neurogenic Orthostatic Hypotension on Healthcare Costs in Patients with Parkinson Disease

2017 American Academy of Neurology (AAN)

Duhig, A. | biaggioni, I. | Shibao, C. | Ogbonnaya, A. | Shih, H. A. | Farelly, E. | Ziemanna, J. | Francois, C. | Volume: , Issue: , Pages: ,

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.