OBJECTIVE: To evaluate healthcare resource utilization (HCRU) patterns in patients with Parkinson’s disease (PD) and motor fluctuations (MF) with carbidopa/levodopa (CD/LD) and other adjunctive PD treatments.
BACKGROUND: Levodopa remains the most effective treatment for PD, but the benefit tends to decrease as disease progresses, resulting in MFs. It is postulated that patients who experience MFs may utilize more healthcare resources, increasing the economic burden of PD.
METHODS: Neurologists treating PD in the United States were invited to participate in this retrospective medical chart review study, which included adult patients (≥18 years) who began experiencing MFs between 01/2014 and 04/2019 while taking CD/LD. Data were abstracted from patients’ medical records (electronic or hard copy) and recorded on a case report form (CRF). HCRU was analyzed from the CRF and reported as: office visits in the past 12 months; annualized rate of PD-related emergency department (ED) visits; and PD-related hospitalizations. HCRU outcomes were compared between patients who had MF for <2 years (MF<2) and those who had MF for ≥2 years (MF≥2).
RESULTS: Based on CRF data (N=310), 193 (62%) patients had MF<2 and 117 (38%) had MF≥2. Overall, the mean number of office visits was 3.5 per year (range, 0-10), with no significant difference between MF<2 and MF≥2 (both, 3.5 visits; P>0.05). Twenty patients had a PD-related ED visit, and the difference between MF≥2 and MF<2 was statistically significant (13% [n=15] vs 3% [n=5]; P<0.001). Thirty patients had a PD-related hospitalization, with a significant difference between MF≥2 and MF<2 (15% [n=18] vs 6% [n=12]; P<0.01). Among patients who were hospitalized, the mean length of stay was shorter in MF≥2 patients than in MF<2 patients, but the difference was not statistically significant (0.5 vs 1.1 days; P>0.05).
CONCLUSIONS: In patients with PD, ED visits and hospitalizations were significantly more frequent in patients with a longer history of MF (≥2 years vs <2 years). MFs, along with other motor and non-motor symptoms, comorbidities, disease duration, and overall medication burden, should be considered when evaluating the impact of PD on HCRU.
