Objective: To assess Parkinson’s disease (PD) burden by means of healthcare resource utilization (HCRU) and clinical outcomes in Israeli PD patients during 20-year period ,2000 – 2019

Background: Long-term disease burden of PD in Israel is under-reported. We set out to explore 20 years of computerized, comprehensive database of Maccabi Healthcare Services (MHS), a nationally representative insurer and provider of 25% of Israel’s population [1], in order to understand the burden of PD as captured by HCRU and PD clinical outcomes.

Method: “eNLIGHTEN” is a retrospective population-based study capturing all MHS PD patients diagnosed by neurologists or hospitals. Index date was defined as the earliest coded PD diagnosis. HCRU and clinical outcomes were identified post-index date and included the following: procedures; visits to neurologist, psychiatrist, ophthalmologist and physical, occupational and speech therapists; and non-pharmacologic and pharmacologic treatments (including device-aided therapies [DATs]).

Results: Study population comprised 9,936 PD patients with median follow-up time post-diagnosis of 4.5 years (IQR: 1.9-8.1), 56% male, and average age at diagnosis of 75 years (SD= 11). The median survival time was 7 years (IQR: 6.7-7.2). A total of 78% of patients initiated treatment within 6 months from index date, 55% of them with Dopa and Dopa derivatives and 6.3% with Dopamine agonists. The 5 and 10-year cumulative incidence rates (CIR) for mild cognitive impairment were 6% and 11%, respectively; corresponding CIRs for dementia 11% and 34%. A two-fold increase from 5- to 10-year CIR was observed for most clinical interventions, including DATs, PEG insertion, continuous positive airway pressure and ventilator support. As PD progressed, the frequency of neurologist visits decreased, whereas occupational, physical and speech therapists visits increased.

Conclusion: HCRU among PD patients in Israel is consistent with current disease management recommendations [2]. Our study provides a detailed description of long- and short-term HCRU in PD, reflecting future resources that may be imposed on healthcare systems with increasing life expectancy.

References: 1. Cohen R and Damari N. 2018. Membership in Sick Funds 2017. National Insurance Institute of Israel, 2018. Retrieved September, 2019, from https://www.btl.gov.il/Publications/survey/Documents/seker_303.pdf (in Hebrew). 2. Armstrong MJ, Okun MS. JAMA. Diagnosis and Treatment of Parkinson Disease: A Review. 2020 Feb;323(6):548-560.

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