Analysis of Medicare Patients Treated with Pimavanserin versus Other Atypical Antipsychotics: A Cost-Offset Model Evaluating Skilled Nursing Facility Stays and Long-Term Care Admissions in Parkinson’s Disease Psychosis

Figures & data

Figure 1 Model Structure for Annual SNF and LTC Admission Rates and Costs.

Notes: Patients treated with other-AAPs (ie, risperidone, olanzapine, aripiprazole, and quetiapine).

Abbreviations: LTC, Long term care; SNF, Skilled nursing facility; PIM, Pimavanserin; QUE, Quetiapine; AAPs, Atypical antipsychotics; PPPY, Per person per year.

Table 1 PDPM Components and Unadjusted Federal Rates per Diem for Fiscal Year 2022

Components	Urban	Rural
Physical Therapy	$62.82	$71.61
Occupational Therapy	$58.48	$65.77
Speech Language Pathology	$23.45	$29.55
Nursing	$109.51	$104.63
Non-Therapy Ancillaries	$82.62	$78.93
Non-Case Mix Adjusted	$98.07	$99.88

Figure 2 Annual Risk of Admission to LTC and SNF for Medicare Beneficiaries with Evidence of Parkinson’s Disease Psychosis Treated with Pimavanserin, Quetiapine, or Other Atypical Antipsychotics.

Abbreviations: LTC, Long term care; SNF, Skilled nursing facility; PIM, pimavanserin; QUE, quetiapine; AAPs, atypical antipsychotics.

Table 2 Case-Mix Groups Selected and Mean per Diem Rates for SNF/LTC Care

Case-Mix Groups	Description	Rate
Physical Therapy and Occupational Therapy Combined
TM	Non-orthopedic surgery and acute neurologic clinical category with a function score of 0–5	$176.45
TN	Non-orthopedic surgery and acute neurologic clinical category with a function score of 6–9	$204.64
TO	Non-orthopedic surgery and acute neurologic clinical category with a function score of 10–23	$212.94
TP	Non-orthopedic surgery and acute neurologic clinical category with a function score of 24	$149.03
Speech Language Pathology
SH	Acute neurologic clinical category with or without SLP-related comorbidity/ cognitive impairment	$84.51
Nursing
LDE2	Parkinson’s disease with a function score of 0–5 with depression	$217.63
LDE1	Parkinson’s disease with a function score of 0–5 with without depression	$181.01
LBC2	Parkinson’s disease with a function score of 6–14 with depression	$179.96
LBC1	Parkinson’s disease with a function score of 6–14 with without depression	$149.62
Non-therapy ancillaries
NE	One or two comorbid conditions were identified during the SNF stay and related care services were received	$75.77
NF	No other comorbid conditions were present, and no special services were provided	$56.83

Abbreviations: SNF, skilled-nursing facility; LTC, long-term care; TM, nervous system malignancy; TN, nervous system malignancy with major complications or comorbidities; TO, nervous system non-malignancy; TP, nervous system non-malignancy with major complications and comorbidities; SH, non-extensive orthopedic procedure with major complications or comorbidities; LDE/LBC, Parkinson’s disease functional scores with/without depression; NE, non-extensive orthopedic procedures; NF, non-extensive orthopedic procedures with major complications or comorbidities; SLP, speech language pathology.

Table 3 Case-Mix Component and Total per Diem Rate of Rehabilitation on Annualized Basis

Component	Group	Per Diem Rate
PT + OT	Non-Orthopedic Surgery and Acute Neurologic (TM, TN, TO, TP)	$144.95
SLP	(i) Presence of Acute Neurologic Condition, SLP-Related Comorbidity, or Cognitive Impairment and (ii) mechanically altered diet or swallowing disorder (SH)	$84.51
Nursing	Special Care Low; (i) Nursing function score 0–14 and (ii) with or without depression (LDE2, LDE1, LBC2, LBC1)	$182.06
NTA	Score range of 0–2 (NE, NF)	$56.83
Non-Case Mix (room and board services)	N/A	$98.98
Total		$567.33

Abbreviations: PT, physical therapy; OT, occupational therapy; SLP, speech language pathology; NTA, non-therapy ancillary; N/A, not applicable; TM, nervous system malignancy; TN, nervous system malignancy with major complications or comorbidities; TO, nervous system non-malignancy; TP, nervous system non-malignancy with major complications and comorbidities; SH, non-extensive orthopedic procedure with major complications or comorbidities; LDE/LBC, Parkinson’s disease functional scores with/without depression; NE, non-extensive orthopedic procedures; NF, non-extensive orthopedic procedures with major complications or comorbidities.

Figure 3 (A) Total Costs and Cost-Savings Within Each PDPM Component and Overall, For Long-Term Care Admissions (PIM VS QUE). (B) Total Costs and Cost-Savings Within Each PDPM Component and Overall, For Long-Term Care Admissions (PIM VS Other-AAPs).

Abbreviations: LTC, long term care; PIM, pimavanserin; QUE, quetiapine; AAPs, atypical antipsychotics; PT, physical therapy; OT, occupational therapy; SLP, speech language pathology; NTA, non-therapy ancillary.

Figure 4 (A) Total Costs and Cost-Savings within Each PDPM Component and Overall, for Skilled Nursing Facility Admissions (PIM vs QUE). (B) Total Costs and Cost-Savings within Each PDPM Component and Overall, for Skilled Nursing Facility Admissions (PIM vs other-AAPs).

Abbreviations: SNF, skilled nursing facility; PIM, pimavanserin; QUE, quetiapine; AAPs, atypical antipsychotics; PT, physical therapy; OT, occupational therapy; SLP, speech language pathology; NTA, non-therapy ancillary.

Figure 5 Probabilistic Sensitivity Analysis of Skilled Nursing Facility and Long-Term Care Applying 1000 Iterations.

Notes: The horizontal axis provides the number of iterations, and the vertical axis provides cost incurred due to SNF or LTC stays using respective medications (PIM, QUE, and AAPs).

Abbreviations: PSA, probabilistic sensitivity analysis; SNF, skilled nursing facility; PIM, pimavanserin; QUE, quetiapine; AAPs, atypical anti-psychotics.