Objective: To examine health resource utilization (HRU) outcomes among PDP patients treated with PIMA vs. other AAPs.

Background: Real-world analysis demonstrating pimavanserin (PIMA) benefits, the only FDA-approved atypical antipsychotic (AAP) in 2016 for hallucinations and delusions associated with Parkinson’s Disease Psychosis (PDP) is needed.

Method: Analysis of Parts A, B, and D claims from 100% Medicare sample of PDP patients from 01/01/13-12/31/19 was conducted. Patients initiating (i.e., index date) continuous monotherapy of PIMA or other-AAP for ≥12-month during 01/01/14-12/31/18 without any prior-AAP use during 12-month pre-index were selected after 1: 1 propensity score matching on 30 variables (sex, race, region and 27 Elixhauser comorbidity characteristics). HRU outcomes included: annual all-cause and psychiatric-ER visit rates, annual all-cause and psychiatric (i.e., short-term stay, long-term stay, and SNF-stay [skilled nursing facility] hospitalization rates, mean per-patient-per-year (PPPY) hospitalizations and average length-of-stay (ALOS). Differences in PIMA vs other-AAPs were described using chi-square and t-tests. Generalized linear models (GLM) controlled for demographic characteristics, comorbidities, coexisting dementia, and coexisting insomnia were conducted to compare PIMA and other-AAPs.

Results: Of 12,164 PDP patients, approximately 48.41% (n=5,889) were female and mean age was >77 (±8.14) years. Among 1:1 matched PIMA (n=842) vs. other-AAP (n=842) patients, 37.8% (n=319) on PIMA vs. 49.8% (n=420) on other-AAPs (p<0.05) reported ≥1 all-cause hospitalizations. Specifically, short-term and SNF-stay among PIMA patients vs. other-AAPs were: 34% (n=286) vs. 46.2% (n=389) and 20.2% (n=170) vs. 31.8 % (n=267) (p<0.05), respectively. Similarly, 9.6% (n=81) of PIMA vs. 14.6% (n=123) of other-AAPs patients had ≥1 psychiatric hospitalization (p<0.05). Furthermore, patients with ≥1 all-cause and psychiatric ER visit were: 61.6% (n=519) for PIMA vs.69.4% (n=584) for other-AAPs and 5.2% (n=43) for PIMA vs.10.2% (n=86) for other-AAPs (p<0.05), respectively. Mean PPPY short-term hospitalization and SNF stay and ALOS were also significantly lower for PIMA.

Conclusion: In this analysis of PDP patients, PIMA monotherapy resulted in nearly 12% lower all-cause hospitalizations and 7% lower all-cause ER visits vs. other-AAPs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/er-visits-and-hospitalizations-among-patients-treated-with-pimavanserin-or-other-aaps-for-parkinsons-disease-psychosis-analysis-of-medicare-beneficiaries/