Fall-related healthcare use and costs in neurogenic orthostatic hypotension with Parkinson’s disease

Abstract

Aims: To compare patient characteristics, rates, and costs of medically attended falls among patients with Parkinson’s disease (PD) and probable PD plus neurogenic orthostatic hypotension (PD + nOH).

Materials and methods: MarketScan Commercial and Medicare Supplemental databases (January 1, 2009–December 31, 2013) were used to identify PD and probable PD + nOH patients. The first medical or prescription claim suggesting these diagnoses served as the index date. Baseline characteristics and post-index all-cause and fall-related healthcare utilization and costs were compared between patient groups.

Results: A total of 17,421 PD and 281 PD + nOH patients were identified. Compared with PD patients, PD + nOH patients were older (77 vs 74 years; p < .0001) and had more comorbidities. Pre- and post-index date, more PD + nOH patients had a medically attended fall than PD patients (25% vs 20% [p = .0159] and 30% vs 21% [p = 0.0002], respectively). Fallers in both groups had similar numbers of medically attended falls 12-months pre-index (mean =1.9), but PD + nOH fallers had more falls post-index (2.5 vs 2.0; p = .0176). Compared with PD patients, more PD + nOH patients (all p < .01) had fall-related emergency department (ED) visits (18% vs 10%), hospitalizations (7% vs 3%), and non-office visit outpatient services (15% vs 10%). Adjusted total post-index medical costs for falls ($2,260 vs $1,049; p = .0002) and total all-cause costs ($31,260 vs $20,910; p < .0001) were higher for PD + nOH vs PD patients.

Limitations: This study had some limitations. There is no ICD-9-CM diagnosis code for nOH, so a combination of PD and OH diagnoses (with confounding conditions excluded) served as a proxy for an nOH diagnosis. Also, the rate of falls and associated costs in these cohorts might be under-reported because only medically attended falls were evaluated.

Conclusions: PD + nOH patients had a higher prevalence of pre-existing comorbidities and a higher rate of medically attended falls than those with PD alone, leading to increased costs of care.

Keywords:

• Neurogenic orthostatic hypotension
• Parkinson’s disease
• falls
• healthcare costs
• cost of falls

View correction statement:

Corrigendum to: Fall-related healthcare use and costs in neurogenic orthostatic hypotension with Parkinson’s disease

Transparency

Declaration of funding

This study was funded by Lundbeck, LLC. Xcenda, LLC received funding from Lundbeck to conduct this study and develop the manuscript.

Declaration of financial/other relationships

CF is an employee of Lundbeck, LLC, and AZ was an employee of Lundbeck, LLC, at the time of completion of the analyses and preparation of the manuscript. IB and CS are consultants for Lundbeck, LLC. AO, HCS, EF, and AD are employees of Xcenda, LLC.

Acknowledgments

Medical writing support was provided by Laurie Orloski, PharmD (independent medical writer) and funded by Xcenda.

Previous presentations

Presented at the International Parkinson and Movement Disorder Society Congress 2016 (June 2016) and World Parkinson Congress 2016 (September 2016).