Objective: To estimate Parkinson’s Disease (PD)-related health care costs in a national sample of elderly patients in the US and examine the incremental cost burden of advanced PD (APD) vs. mild-moderate PD.

Background: As PD advances, patients develop more debilitating symptoms and are at increased risk for complications. However, little is known about associated health care costs.

Methods: Utilizing 100% fee-for-service Medicare claims from 2013, we identified individuals aged ≥65 years with a PD diagnosis (ICD-9:332.0) and continuous coverage (Medicare Parts A, B, D). Those with pharmacy claims denoting a 30-day average levodopa equivalent dose of >1000 mg/day were classified as APD; others were classified as mild-moderate PD. Treatment claims were categorized based on diagnosis codes, as all-cause (any diagnosis), PD-related (primary diagnosis of PD), and probably PD-related (primary or secondary diagnosis of PD). Annual costs were calculated overall and by category (medical vs. pharmaceutical). Generalized linear models controlling for age, sex, race/ethnicity, region of residence, comorbidity/risk score, and any neurologist visit (yes/no) were used to estimate risk-adjusted total costs for APD and mild-moderate PD. Adjusted incremental costs of APD over mild-moderate PD were calculated.

Results: In the analytical sample (n=144,703), 28,974 individuals (20%) met our criterion for APD. For 2013, total all-cause costs were $21,947 for APD and $19,809 for mild-moderate PD. PD-related costs were $5,779 vs. $2,319 and probably PD-related costs were $12,229 vs. $7,836, respectively for APD and mild-moderate PD. For probably PD-related costs, the APD group had higher medical costs ($7,877 vs. $5,862) and pharmaceutical costs ($4,353 vs. $1,974), compared to the mild-moderate PD group. After risk-adjustment, the incremental costs of APD were $5110 (95%CI: $4,752-$5,467) for all-cause costs; $3,201 (95%CI: $3,060-$3,343) for PD-related costs; and $5,347 (95%CI: $5,075-$5,619) for probably PD-related costs (p<0.001, all models).

Conclusions: This study is the first to estimate the economic burden of APD in a national sample of US Medicare enrollees with prevalent APD identified using a medication based proxy. Understanding the excess costs associated with APD will help policy makers and practitioners allocate resources and set priorities to improve outcomes in this population.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/economic-burden-of-advanced-parkinsons-disease-in-a-national-sample-of-elderly-us-medicare-beneficiaries-a-prevalence-based-estimate/