Intermediate Parkinson Disease Associated With Significant Clinical, Economic Burden

Patients with intermediate Parkinson disease (PD) have significantly greater health care resource utilization (HCRU) and disease burden compared with patients in early stages of their disease, according to findings of a poster presented at the Academy of Managed Care Pharmacy Nexus 2022 meeting.

As the most rapidly increasing neurological disorder globally, the researchers noted that PD has a well-outlined global burden on the health care system. An estimated 3.2 million disability-adjusted life-years are attributed to PD, with previous estimates indicating the total economic burden of the disease in the United States to be $51.9 billion annually.

However, as research tends to focus on patients at the early or severe end of the condition spectrum, the impact upon the health care system associated with patients with PD at more intermediate stages is often overlooked, said the authors.

Leveraging the Hoehn & Yahr (H&Y) scale to classify symptom progression and level of disability in patients with PD, they sought to describe the HCRU in people with PD at different H&Y stages in the United States. Data for the analysis were collected from the Adelphi PD Specific Programme, a cross-sectional, point-in-time survey of neurologists and their patients with PD in the United states from 2021 to 2022.

Ninety-five neurologists provided data via the physician-completed record form on 1251 patients with PD who were grouped by current H&Y stages as early (1-2), intermediate (2.5-3), or severe (4-5). Patients were compared on HCRU (number of consultations and hospitalizations in the last 12 months), caregiver requirements (hours spent caring per week), and prescribed treatments over the last 12 months.

“Bivariate analysis compared a range of outcomes between patients at their differing H&Y stages. Regression analysis was conducted, with H&Y score being the main predictor variable,” explained the researchers. “All analyses were adjusted for patient age, sex, and body mass index.”

Of the study cohort, 47% were classed as early-stage PD (n = 593), 40% intermediate (n = 505), and 12% severe (n = 153), for whom mean numbers of current anti-PD treatments increased with worsening severity (intermediate PD: incidence rate ratio [IRR], 1.73; P < .05).

Specific to the increase in HCRU from early to intermediate PD, significantly more levodopa prescribing (IRR, 5.57; P < .05), emergency department visits (IRR, 3.80; P < .05), and admissions to rehabilitation centers (IRR, 6.83; P < .05) were observed among patients with intermediate disease.

Moreover, the number of physicians and consulting neurologists involved in managing a patient’s PD were significantly greater for the intermediate than early group (IRR, 1.14; P < .05). Total weekly caregiving hours required was also significantly higher for the intermediate vs early group (IRR, 12.22; P < .05).

Based on the study findings, the researchers concluded there is an opportunity and need for new PD treatment options that stabilize or improve patient health at the intermediate stage.

“A new product helping to slow and smooth the steep decline over the condition course could significantly reduce the burden upon patients with PD, their caregivers, and the US health care system.”

Reference

Ciepielewska M, Hagan M, Jones E, Gillespie A, Walker C, Le Brocq L. Assessing the clinical and economic burden experienced by patients with intermediate Parkinson’s disease: results from a real-world study. Presented at: AMCP Nexus 2022; October 11-14, 2022; National Harbor, MD. Abstract G3.