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

Figures & data

Figure 1. Patient attrition for the (a) PD cohort, and (b) PD + nOH cohort. *Non-mutually exclusive criteria. †Required for a secondary analysis (results not presented). OH: orthostatic hypotension; PD: Parkinson’s disease; PD + nOH: Parkinson’s disease with neurogenic orthostatic hypotension. Note: Because the data extract included patients with a diagnosis for OH or PD, patients with only a prescription for OH medication without an OH diagnosis or a prescription for PD medication without a PD diagnosis during the study period represent only a sub-set of all such patients.

Table 1. Demographic characteristics of PD and PD + nOH patients.

	PD (n = 17,421)		PD + nOH (n = 281)		p-value PD + nOH vs PD
	n	%	n	%
Age
Mean (SD)	74 (11)		77 (8)		<.0001
<65 years	4,148	24%	22	8%	<.0001
≥65 years	13,273	76%	259	92%
Gender
Female	7,093	41%	91	32%	.0048
Region
Northeast	2,839	16%	44	16%	.6498
North Central	6,306	36%	93	33%
South	4,737	27%	81	29%
West	3,499	20%	63	22%
Unknown	40	0%	0	0%
Urbanicity
Urban	14,772	85%	234	83%	.5475
Rural	2,613	15%	47	17%
Unknown	36	0%	0	0%
Payer type
Commercial	4,323	25%	20	7%	<.0001
Medicare	13,098	75%	261	93%
Plan type
Comprehensive	7,423	43%	130	46%	.5776
Preferred provider organization/Exclusive provider organization	6,272	36%	102	36%
Point of service	820	5%	11	4%
Health maintenance organization	2,076	12%	28	10%
Consumer-driven health plan/High-deductible health plan	299	2%	2	1%
Unknown	531	3%	8	3%
Capitation
Yes	1,117	6%	17	6%	.8058
No	16,304	94%	264	94%
Index year
2010	15,723	90%	266	95%	.0458
2011	943	5%	8	3%
2012	755	4%	7	2%

PD: Parkinson’s disease; PD + nOH: Parkinson’s disease with neurogenic orthostatic hypotension; SD: standard deviation.

Table 2. Clinical characteristics of PD and PD + nOH patients.

	PD (n = 17,421)		PD + nOH (n = 281)		p-value PD + nOH vs PD
	n	%/SD	n	%/SD
	Charlson Comorbidity Index score (12 months prior to the index)
Mean (SD)	1.3	(1.6)	1.5	(1.7)	.084
0	7,573	43%	93	33%	.0011
1	3,841	22%	81	29%
≥2	6,007	34%	107	38%
Specific comorbidities (12 months prior to the index)
Syncope and collapse	921	5%	72	26%	<.0001
Dizziness and giddiness	1,263	7%	49	17%	<.0001
Dementia	692	4%	18	6%	.0392
Diabetes	3,391	19%	38	14%	.0124
Congestive heart failure	1,243	7%	28	10%	.0684
Atherosclerosis	3,706	21%	72	26%	.0775
Hypertension	8,186	47%	118	42%	.0959
Renal disease	775	4%	14	5%	.6672
Varicose vein	750	4%	7	2%	.1360
End-stage renal disease	39	0%	0	0%	.4272
Medically attended falls (12 months prior to the index)
n (%) of patients	3,399	20%	71	25%	.0159
Mean # of falls among the group w/falls (SD)	1.9	(1.5)	1.9	(1.4)	.7287
Concomitant medications (12 months prior to the index)
Medications used to treat Parkinson’s disease:
Dopamine agonists	6,784	39%	121	43%	.1602
Monoamine oxidase inhibitors	2,692	15%	46	16%	.6731
Catechol-O-methyltransferase inhibitors	972	6%	26	9%	.0081
Anti-Parkinson anti-cholinergics	763	4%	5	2%	.0338
Medications used to treat orthostatic hypotension:
Pyridostigmine	22	0%	8	3%	<.0001
Erythropoietin	0	0%	0	0%	NA
Octreotide	1	0%	0	0%	.8989
Medications that may cause orthostatic hypotension:
Diuretics	4,594	26%	49	17%	.0007
Alpha-blockers	2,444	14%	58	21%	.0016
Beta-blockers	4,633	27%	58	21%	.0249
Other anti-hypertensives	126	1%	2	1%	.9820
Nitrates	1,214	7%	18	6%	.7130
Insulin	792	5%	7	2%	.0097
Phenothiazines	233	1%	1	0%	.1529
Phosphodiesterase type 5 inhibitors	927	5%	19	7%	.2869
Tricyclic antidepressants	585	3%	9	3%	.8861
Non-tricyclic antidepressants	1,606	9%	29	10%	.5270
Clonidine	308	2%	5	2%	.9885
Narcotics	2,210	13%	32	11%	.5164
Other medications:
Angiotensin-converting enzyme inhibitors	4,137	24%	35	12%	<.0001
Angiotensin-receptor blockers	2,413	14%	18	6%	.0003
Calcium-channel blocker	3,513	20%	29	10%	<.0001
Other antidepressants	4,763	27%	109	39%	<.0001

PD: Parkinson’s disease; PD + nOH: Parkinson’s disease with neurogenic orthostatic hypotension; SD: standard deviation.

Table 3. Adjusted percentage of patients with at least one medically attended fall and number of medically attended falls over the 12-month post-index period.

	PD (n = 16,304)	PD + nOH (n = 264)	Difference (95% CI) PD + nOH vs PD
Adjusted percentage of patients with medically attended falls	21.2%	25.6%	4.5% (−0.2–9.7%)
Adjusted mean number of medically attended falls	0.42	0.68	0.26 (0.17–0.38)

CI: confidence interval; PD: Parkinson’s disease; PD + nOH: Parkinson’s disease with neurogenic orthostatic hypotension.

Table 4. Medically attended fall-related and all-cause healthcare utilization in the 12-month post-index period.

	PD (n = 17.421)		PD + nOH (n = 281)		p-value PD vs PD + nOH
Medically attended fall-related
Outpatient physician office visits
n (%) of patients	1,852	11%	33	12%	.5485
Mean (SD) visits	1.7	(1.4)	1.8	(1.6)	.6998
Other outpatient visits
n (%) of patients	1,678	10%	42	15%	.0028
Mean (SD) visits	4.3	(6.6)	7.3	(13.6)	.1655
Emergency room visits
n (%) of patients	1,666	10%	51	18%	<.0001
Mean (SD) visits	1.2	(0.6)	1.3	(0.8)	.4562
Inpatient stays
n (%) of patients	531	3%	19	7%	.0004
Mean (SD) visits	1.4	(0.8)	1.5	(1.0)	.7071
Mean (SD) length of stay	7.4	(7.6)	6.4	(4.4)	.3478
All-cause
Outpatient office visits
n (%) of patients	16,687	96%	270	96%	.8046
Mean (SD) visits	10.6	(7.2)	11.7	(6.8)	.0124
Other outpatient visits
n (%) of patients	16,435	94%	273	97%	.0422
Mean (SD) visits	17.3	(18.8)	21.2	(18.9)	.0007
Emergency department visits
n (%) of patients	6,478	37%	163	58%	<.0001
Mean (SD) visits	1.9	(1.6)	2.4	(1.7)	.0002
Inpatient stays
n (%) of patients	4,908	28%	143	51%	<.0001
Mean (SD) visits	1.9	(1.5)	2.2	(1.9)	.0485
Mean (SD) length of stay	10.8	(19.5)	13.1	(18.7)	.1757
Outpatient pharmacy services
n (%) of patients	17,334	100%	280	100%	.7343
Mean (SD)	45.0	(32.8)	56.5	(35.0)	<.0001

PD: Parkinson’s disease; PD + nOH: Parkinson’s disease with neurogenic orthostatic hypotension; SD: standard deviation.

Table 5. Medically attended fall-related and all-cause healthcare costs in the 12-month post-index period.

	PD (n = 16,304)		PD + nOH (n = 264)		PD + nOH vs PD
	Mean $	SD	Mean $	SD	p-value
Unadjusted medically attended fall-related costs
Medical costs	1,049	6,005	2,260	8,905	.0002
Outpatient physician office costs	47	381	31	123	.8548
Other outpatient costs	307	2,768	704	4,537	.0019
Emergency department costs	166	990	338	1,493	<.0001
Inpatient costs	528	4,521	1,187	5,473	.0006
Unadjusted all-cause costs
Total costs	20,910	28,801	31,260	32,805	<.0001
Medical costs	15,015	27,925	23,749	32,426	<.0001
Outpatient physician office costs	1,931	3,195	2,056	2,135	.0021
Other outpatient costs	6,966	14,359	9,859	13,942	<.0001
Emergency department costs	888	2,728	1,897	3,575	<.0001
Inpatient costs	5,229	18,219	9,937	24,019	<.0001
Pharmacy costs	5,895	5,324	7,511	5,011	<.0001
					Difference (95% CI)
Adjusted medically attended fall-related costs	1,047		2,519		1,471 (715–2,553)
Adjusted all-cause total costs	20,950		30,428		9,478 (6,336–12,982)
Adjusted all-cause medical costs	15,117		22,896		7,779 (4,679–11,366)

CI: confidence interval; PD: Parkinson’s disease; PD + nOH: Parkinson’s disease with neurogenic orthostatic hypotension; SD: standard deviation.