Objective: To describe healthcare resource use (HCRU) and related costs among Parkinson’s patients with dementia (PDD) and psychosis compared with other dementia types in a nationally representative sample in the US.

Background: Dementia affects approximately 7.9 million people in the US (1). Of these, about 1.2 million have dementia-related psychosis (DRP) (2), a functionally disruptive symptom that occurs in all dementia types. There are limited published data on burden of illness in these patients, their HCRU, and related costs within the US healthcare system.

Method: Using Medicare Part A, B, and D data from 2008-2016, patients with PDD and psychosis (PDD+P) but no other obvious etiology of dementia were identified to compare with patients with other types of dementia, viz. Alzheimer’s (AD), dementia with Lewy bodies (DLB), frontotemporal (FTD), vascular (VaD), other/unspecified dementia (UD). The dementia index date was defined as the date of diagnosis. Patients were required to have 12 months of Medicare enrollment prior to index date. Costs and HCRU were described in the 12 months after index date for patients with PDD+P. HCRUs included inpatient (IP), emergency room (ER), outpatient (OP), skilled nursing facility (SNF), and Part B (physician) visits. Patients with PDD+P were compared descriptively with the other dementia types. Costs were reported in 2015 $US.

Results: Of all DRP patients, patients with PDD constituted 6.5% of all dementia, and PDD+P (n=367) constituted 0.7% of all DRP patients. Compared with other dementia types, the mean HCRU claims per patient per year was highest for PDD+P patients with 1.8 ER/7.8 OP versus 1.4/6.7, 1.4/7.3, 1.2/5.8, 1.5/7.5, 1.6/7.2 for AD+P, DLB+P, FTD+P, VaD+P, and UD+P respectively. PDD+P patients had the highest mean annualized cost OP ($4806) and SNF ($12,603). Mean total annualized all-cause costs during post index for PDD+P patients were $71,319, similar to FTD+P ($72,869) but less than AD+P ($89,305), DLB+P ($99,855), VaD+P ($99,298), and UD+P ($84,453).

Conclusion: Patients with PDD+P had the highest HCRU rates of ER and OP visits and incurred the most costs related to OP and SNF. Further analysis needs to be conducted to identify factors associated with the increase in costs among the different dementia categories versus PDD+P patients and control for any confounding bias.

References: 1. World Health Organization Dementia Key Facts Sheet 12 December 2017. 2. 2017 Alzheimer’s Disease Facts and Figures and ACADIA market research.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/healthcare-resource-utilization-and-costs-of-parkinsons-disease-dementia-with-psychosis-in-the-us-medicare-population/