J Neurol Sci. 2012 Jun 2. [Epub ahead of print]
Suh DC, Pahwa R, Mallya U.
Source
College of Pharmacy, Chung-Ang University, Seoul, South Korea.
Abstract
OBJECTIVES:
This
study examined the treatment patterns, direct healthcare costs and
predictors of treatment costs associated with levodopa-induced
dyskinesia (LID) in Parkinson's disease (PD).
METHODS:
This
retrospective cohort study followed PD patients for 1-year pre- and
post-onset of LID, using a large US health insurance claims database
from January 1, 2004 to December 31, 2008. Patients with LID were
matched to patients without LID based on propensity scores to control
for potential selection bias. Descriptive statistics and bootstrap
techniques were employed to assess patient demographic and clinical
characteristics and costs incurred. Factors influencing treatment costs
were analyzed using a generalized linear model with log-link function
and gamma distribution. Costs were adjusted to 2009 prices.
RESULTS:
After
patients developed LID, their total treatment costs were increased from
$18,645 during the 12months preceding LID onset to $26,439 for the
12-month period subsequent to LID onset (incremental costs of $7795:
P<0.001). PD-related costs increased from $3917 to $8110
(incremental costs of $4194: p<0.001) LID events, medical resource
utilization, higher levodopa dosage, and use of alternative PD
medications were associated with increases in total treatment costs.
Few changes in medication treatment patterns were noted following the
initial LID, with only slight increases in levodopa dosage and few
additions of alternative agents.
CONCLUSIONS:
In the
United States, PD patients with LID impose a significant economic
burden when compared to patients without LID. Currently available,
treatment strategies for dyskinesia should be used more frequently in
PD management, and new treatment strategies should be considered as
they may lower healthcare costs.
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